Analyzing the proposed reconfiguration of accident-and-emergency facilities in England
The Keogh Report of 2013 proposed a major reconfiguration of the accident and emergency (A&E) system under National Health Service (NHS) England to improve service. The proposed reconfiguration includes centralized facilities with multiple specialties as well as small local minor-injury facilities. We use stylized queuing models to analyze cost and service implications of the proposed reconfiguration. We find that increasing numbers of specialty patients that require admission to hospital makes splitting off specialty A&Es from general ones more attractive. The same applies for patients with minor injuries. Our work generally supports the reconfiguration recommended in the Keogh report but with some fine-tuning: For instance, a merger of A&Es (pooling) does not always make sense even though it increases patient numbers when the patients in the two A&Es are of different types. We provide simple quantitative rules to indicate whether the proposed reconfiguration could lower costs in any particular region of the country. The results here are consistent with some NHS England providers attempting specialty A&Es for geriatric patients and mobile drunkenness treatment centers on weekends. Our rules and approach can be useful for identifying candidate reconfiguration opportunities not only for NHS England but also for any other context where pooling and arrival heterogeneity are important considerations.