Skip to main content

Acute hospital reconfiguration and self-harm presentations: a before-and-after study



The evidence for improved patient outcomes following acute hospital reconfiguration is limited.


We assessed the impact of the reconfiguration of acute services within a hospital group in terms of the number and clinical management of self-harm presentations.


The study was conducted across the three Mid-Western regional hospitals in Ireland during 2004–2014. Reconfiguration in April 2009 involved two hospitals reducing the operation of their emergency departments (EDs) from 24 to 12 h. We used Poisson regression analysis of data from the National Self-Harm Registry Ireland to assess change in the hospital burden and clinical management of self-harm associated with the reconfiguration.


We observed that the cumulative decrease in self-harm presentations at the two reconfigured hospitals was of a similar magnitude to the increase observed at the larger hospital. Despite this large increase in presentations, there was only a small increase in admissions. Reconfiguration of hospital services was also associated with changes in the provision of assessments for self-harm patients.


There is evidence to suggest that acute hospital reconfiguration of hospital services impacts on patterns of patient flow. Findings have implications for those implementing reconfiguration of acute services.

This is a preview of subscription content, access via your institution.


  1. 1.

    Health Service Executive (2014) Securing the future of smaller hospitals: a framework for development. HSE, Dublin

    Google Scholar 

  2. 2.

    National Health Service (2014) Five Year Forward View. NHS, London

    Google Scholar 

  3. 3.

    Imison C (2015) The reconfiguration of hospital services: is there evidence to guide us? Future Hosp J 2:137–141

    Article  Google Scholar 

  4. 4.

    Bennewith O, Gunnell D, Peters T, Hawton K, House A (2004) Variations in the hospital management of self harm in adults in England: observational study. BMJ 328:1108–1109

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Cooper J, Steeg S, Bennewith O, Lowe M, Gunnell D, House A, Hawton K, Kapur N (2013) Are hospital services for self-harm getting better? An observational study examining management, service provision and temporal trends in England. BMJ Open 3:e003444

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Perry IJ, Corcoran P, Fitzgerald AP, Keeley HS, Reulbach U, Arensman E (2012) The incidence and repetition of hospital-treated deliberate self harm: findings from the world’s first national registry. PLoS One 7:e31663

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Health Service Executive (2008) Review of acute hospital services in HSE mid-west: an action plan for acute and community health services. HSE, Dublin

    Google Scholar 

  8. 8.

    Shanahan E, Keenan R, Cunningham N, O'Malley G, O’Connor M, Lyons D, Peters C (2015) Acute stroke unit improves stroke management-four years on from INASC. Ir Med J 108:51–53

    CAS  PubMed  Google Scholar 

  9. 9.

    Griffin E, Arensman E, Corcoran P et al (2016) National Self-Harm Registry Ireland Annual Report 2015. National Suicide Research Foundation, Cork

Download references


The National Self-Harm Registry Ireland is funded by the Irish Health Service Executive’s National Office for Suicide Prevention.

Author information



Corresponding author

Correspondence to Eve Griffin.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The National Research Ethics Committee of the Faculty of Public Health Medicine, Dublin granted ethical approval for the National Self-Harm Registry Ireland. The Registry has also received ethical approval from the relevant hospitals and Health Service Executive (HSE) ethics committees. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Griffin, E., Murphy, C., Perry, I.J. et al. Acute hospital reconfiguration and self-harm presentations: a before-and-after study. Ir J Med Sci 188, 1–4 (2019).

Download citation


  • Acute health services
  • Hospital reconfiguration
  • Self-harm