Acute hospital reconfiguration and self-harm presentations: a before-and-after study

The evidence for improved patient outcomes following acute hospital reconfiguration is limited.

We assessed the impact of the reconfiguration of acute services within a hospital group in terms of the number and clinical management of self-harm presentations.

The study was conducted across the three Mid-Western regional hospitals in Ireland during 2004-2014. Reconfiguration in April 2009 involved two hospitals reducing the operation of their emergency departments (EDs) from 24 to 12 h. We used Poisson regression analysis of data from the National Self-Harm Registry Ireland to assess change in the hospital burden and clinical management of self-harm associated with the reconfiguration.

We observed that the cumulative decrease in self-harm presentations at the two reconfigured hospitals was of a similar magnitude to the increase observed at the larger hospital. Despite this large increase in presentations, there was only a small increase in admissions. Reconfiguration of hospital services was also associated with changes in the provision of assessments for self-harm patients.

There is evidence to suggest that acute hospital reconfiguration of hospital services impacts on patterns of patient flow. Findings have implications for those implementing reconfiguration of acute services.