title: Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment.
abstract: OBJECTIVE
  Reducing emergency admissions is a priority for the NHS. A single hospital's emergency care system was reorganised with the principles of front-loaded investigations, integration of specialties, reduced duplication, earlier decision making by senior clinicians and a combined emergency assessment area. The authors relocated our Medical Assessment Unit into our emergency department in 2006. The authors evaluated changes in admissions and mortality before and after 2006, compared with other similar hospitals.
  
  
  METHODS
  Quasi-experimental before and after study using routinely collected data.
  
  
  METHODS
  1 acute hospital in England, the intervention site, was compared with 23 other English hospitals between 2001 and 2009.
  
  
  METHODS
  Our outcome measures were hospital standardised mortality ratios (HSMRs) for non-elective admissions and standardised admission ratios (SARs).
  
  
  RESULTS
  The authors observed a statistically and clinically significant decrease in HSMR and SAR. The intervention hospital had the lowest HSMR and SAR of all the hospitals in our sample. This was statistically significant, p=0.0149 and p=0.0002, respectively.
  
  
  CONCLUSIONS
  Integrating emergency care in one location is associated with a meaningful reduction in mortality and emergency admissions to hospital.
authors.affiliation: Emergency Department, Cambridge University Foundation Hospitals NHS Trust, Cambridge, UK.
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Boyle
authors.forename: Vazeer
authors.initials: V
authors.lastname: Ahmed
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Palmer
authors.forename: Tom J H
authors.initials: TJ
authors.lastname: Bennett
authors.forename: Susan M
authors.initials: SM
authors.lastname: Robinson