Centralization of emergency hospital care is not associated with increased in-hospital mortality; a population-based cohort study.

Abstract

We describe changes in the distance travelled, the utilization of emergency services, and the inhospital mortality before and after the centralization of hospital emergency services in Denmark. All unplanned non-psychiatric hospital contacts from adults (aged ≥18 years) in 2008 and 2016 are included. Analyses are age-standardized and conducted at a municipality level. The municipalities are divided into groups according to the presence of emergency hospital services. Municipalities where hospitals with emergency services have been closed differed by having the most significant increase in distance travelled from 2008 to 2016. All groups experienced a reduction in overall in-hospital mortality. The reduction in mortality was not present for acute myocardial infarct contacts from municipalities where hospitals with emergency services have been closed. Our data do not suggest that hospital closures, and thereby increased travel distance, have contributed significantly as a barrier to emergency-care access and changes to in-hospital mortality.