Emergency department reorganisation introducing increased autonomy: A mixed effects approach to evaluate the effects of a national policy

In 2007, a Danish national policy to future-proof emergency department (ED) performance was launched. The policy included several recommendations for the management and organisation of care that essentially introduced greater ED autonomy. In this study, we evaluate the effects of increased ED autono...

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Bibliographic Details
Published in:PloS one 2023-03, Vol.18 (3), p.e0283325-e0283325
Main Authors: Tipsmark, Line Stjernholm, Obel, Børge, Andersson, Tommy, Søgaard, Rikke
Format: Article
Language:English
Subjects:
Autonomy
Biology and Life Sciences
Care and treatment
Costs
Critically ill
Cross-Sectional Studies
Domestic policy
Emergency medical care
Emergency medical services
Emergency service
Emergency Service, Hospital
Employment
Erysipelas
Evaluation
Family physicians
Government programs
Health aspects
Health care policy
Heterogeneity
Hip
Hip Fractures
Hospitals
Humans
Information processing
Intervention
Medicine and Health Sciences
Mortality
Patient Readmission
Patients
People and Places
Policy
Questionnaires
Retrospective Studies
Social aspects
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Summary:In 2007, a Danish national policy to future-proof emergency department (ED) performance was launched. The policy included several recommendations for the management and organisation of care that essentially introduced greater ED autonomy. In this study, we evaluate the effects of increased ED autonomy on readmission, mortality and episode costs for two large patient groups. A non-randomised stepped wedge study-design where all EDs gradually implemented the policy at different steps during the study period (2008-2016). The timing and extent of policy implementation was determined from a retrospective cross-sectional survey of all 21 Danish EDs. This was linked to all episodes of hip fracture (n = 79,697) and erysipelas (n = 39,900) identified in the Nation Patient Registry and with episode-level outcomes. Mixed effect models were specified for the outcomes of 30-day readmission, 30-day mortality and episode costs, and adjusted for relevant ED- and episode-level heterogeneity. Increased ED autonomy was associated with more readmissions (p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0283325