City Research Online

Abstract

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 reconfig-uration includes centralized facilities with multiple specialties as well as small local minor-injuryfacilities. We use stylized queuing models to analyze cost and service implications of the proposedreconfiguration. We find that increasing numbers of specialty patients that require admission tohospital makes splitting off specialty A&Es from general ones more attractive. The same appliesfor 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 notalways make sense even though it increases patient numbers when the patients in the two A&Esare of different types. We provide simple quantitative rules to indicate whether the proposed recon-figuration could lower costs in any particular region of the country. The results here are consistentwith some NHS England providers attempting specialty A&Es for geriatric patients and mobiledrunkenness treatment centers on weekends. Our rules and approach can be useful for identifyingcandidate reconfiguration opportunities not only for NHS England but also for any other contextwhere pooling and arrival heterogeneity are important considerations.

Publication Type:	Article
Additional Information:	This is the peer reviewed version of the following article: Jiang, H. and Sodhi, M. (2019). Analyzing the Proposed Reconfiguration of Accident-and-Emergency Facilities in England. Production and Operations Management, which has been published in final form at https://onlinelibrary.wiley.com/journal/19375956. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Publisher Keywords:	Healthcare policy, accident-and-emergency service, queuing models, pooling and splitting, merger
Subjects:	H Social Sciences > HD Industries. Land use. Labor H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management R Medicine > RA Public aspects of medicine
Departments:	Bayes Business School > Management
SWORD Depositor:	Symplectic Administrator

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