Abstract
Background The consequences of economization and staff shortage in the
German health care system strongly affect paediatric care structures, especially
in rural regions. It is not known how closures of paediatric departments
influence patient flows of surrounding hospitals. Here, we investigate the
quantitative effects of closure of the paediatric department of a district
hospital and the subsequent opening of an alternative inpatient service on the
utilisation of inpatient and outpatient care services of the two neighboring
hospitals and the emergency services of the region.
Methodology In the observation period from 2015 to 2019, patient-related
data from the three hospitals in the study region as well as data from the
rescue service were evaluated.
Results In the year after the paediatric department of the district
hospital was closed in 2016, the total number of inpatient cases in the region
decreased by 33% (2015: n=1,787; 2016: n=1,193) and then
decreased by an additional 11% (2019: n=1,005). The number of
outpatient cases decreased by further 8% (2015: n=6,250; 2019:
n=5,770). In the last observation year, emergency services were used
much more frequently than in the year before the closure (2015: n=398;
2019: n=572). This means an increase of 44%.
Conclusion After the closure of the paediatric department, the total
number of inpatient cases in the region fell sharply. However, actual gaps in
care apparently did not arise. Before closing, the consequences for the
surrounding hospitals should be assessed more precisely. Real gaps in care must
be counteracted, e. g. through alternative outpatient services.
Key words
paediatrics - inpatient care - regional care - rescue service - patient flows
