Emergency condition fatalities show decade of decline

A study shows the number of fatalities from serious emergency conditions fell in the 13 years from 2002, the decline slowing considerably once the recession hit.

However, the study stresses it cannot attribute any slowing down in the case fatality ratio to the impact of the recession, but nor can it point to the reconfiguration of emergency department services in the same period as the reason for the general improvement, given some geographical variations.

The study, entitled Case fatality ratios for serious emergency conditions in the Republic of Ireland was published last week in the ‘BMC Health Services Research’ journal and examined figures for the years 2002 to 2014.

It found, over that period nationally, there was an annual fall if the case fatality ratio (CFR) of 2.1%, but that the decline was faster from 2002 to 2007, compared with 2007 to 2014.

Overall, the south-east had a lower rate of decrease, while the west had a higher rate of decrease.

Those behind the study considered 16 serious emergency conditions, grouped into three categories: Stroke; acute myocardial infarction/cardiac arrest; and ‘other’, including road traffic collisions and self-harm.

Analysis of the results show the national annual CFR for 2002-2004 was 187 per 1,000, falling to 151 per 1,000 by the latter years of the study period 2012 - 2014.

According to the study: “There is little evidence that identified changes in CFRs at a regional or county level were associated with the reconfiguration of services, such as the removal of emergency departments.”

It said the findings revealed “a complex picture” and that while outcomes have improved, the national rate of improvement has slowed in recent years.

“The findings presented in this paper suggest that reconfiguration in Ireland, mainly implemented after 2006, has not resulted in improved outcomes, and has not altered long-term geographical differences between regions and counties,” said the report. “This may be due to poor resourcing and implementation of reconfiguration plans. It may also be due to long-term structural differences between geographical areas in social determinants of health such as rurality and deprivation.

“Our findings show that changes to the national CFR trend coincided with a period of recession in Ireland. With additional budget allocations as of 2015, further monitoring will determine if there are future improvements to CFRs. Additionally, policies of reconfiguration do not appear to have significantly influenced CFRs.

“Changes to fatality trends varied by condition, therefore results cannot be solely attributed to recessionary factors.”

The study was led by Brenda Lynch of the School of Public Health in University College Cork.

www.bmchealthservres.biomedcentral.com/track/pdf/10.1186/s12913-018-3260-1 


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