Closing some local services could save lives, report saysBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39056.412755.DB (Published 07 December 2006) Cite this as: BMJ 2006;333:1187
All rapid responses
‘The Future Hospital: the Progressive Case for Change’ suggests that
patients are better treated at specialist centres rather than local
hospitals. Though this may sound like a straightforward conclusion, we
feel the reality is more complex.
A large part of the job of local emergency departments is to
“separate the wheat from the chaff.” The British Heart Foundation (BHF)’s
current ‘Doubt Kills-Ring 999’ media campaign* is a good example of this.
Since the commencement of this campaign in November, we have noticed
an increase in the number of people presenting with undifferentiated chest
pain. In response, we audited attendance and disposal of patients
presenting with this symptom to our Emergency department; comparing
figures from November 2006 with the same period in the previous year.
In Nov. 2005, 275 patients attended with undifferentiated Chest pain.
Of these 59 (21.5%) were subsequently admitted to the wards or transferred
to a Cardiac Catheter lab after initial investigations. By contrast, in
Nov. 2006 (the month in which the BHF campaign started), 396 patients
attended the department with the same complaint (an increase of 44% from
the previous year). Of these 43 were admitted or transferred (i.e.
10.6%). It is notable that though the total number of admissions for
further investigations or treatment has decreased, in part due to better
near-patient testing, the attendance rate has soared.
We feel that not only does this raise concerns about whether such
media campaigns achieve their objective of saving lives; but also whether
bypassing local hospitals will simply swamp both the Specialist centres as
well as the ambulance services with the increased number of 'worried
Competing interests: No competing interests