Eighth principle in reconfiguring acute hospital servicesBMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7227.122 (Published 08 January 2000) Cite this as: BMJ 2000;320:122
EDITOR—Smith describes the seven principles that should be followed when reconfiguring acute hospital services.1
There is an eighth principle, most important of all for economy—that no condition manageable in a spoke should ever progress to or remain in a hub. This entails bottom up rather than top down planning. Ninety per cent of all contacts are handled in primary care and 50% of inpatients and 90% of “casualties” can be managed in minor injury units. Trauma centres and super-specialist units are the way ahead for a minority of patients. The majority must be prevented at all costs (sic) from entering them.