Background The Health Service Executive (HSE) has embarked on a series of regional system re-designs to radically change the organisation of urgent and emergency care delivery in Ireland, at a time when budgets and staff levels have been substantially reduced and there is growing awareness of problems with quality and safety. The general purpose of this initiative is to “develop integrated services across all stages of the care journey” with the goal of increasing efficiency and improving performance. Major changes initiated so far include the reconfiguration of acute hospital services and the introduction of ambulance bypass protocols. Our aim was to identify and describe the typology of models employed in re-designing urgent and emergency care services, with a specific focus on the use of evidence and resources.

Methods Two qualitative methods were employed. A documentary analysis was conducted of current national and regional policy documents. Also, approximately 200 semi-structured interviews were conducted with key stakeholders providing urgent and emergency care, along with health service campaigners and local politicians and media, across eight different regions covering the whole of the country. Information from the documentary analysis and interviews was synthesised using NVivo software.

Results Preliminary findings suggest that there are numerous policy initiatives developing in parallel. These are generally well aligned in principle but there is a substantial implementation gap across regions. As a consequence, system re-design to date has taken place in a non-uniform manner across the country with varying levels of implementation and provision of services. Four models have been identified that reflect the re-design of urgent and emergency care services in Ireland, namely: (1) system re-design within existing hospital networks; (2) system re-design to formalise and amalgamate individual hospital networks with current group structures; (3) system re-design to maintain academic relations; and (4) system re-design at planning stage. There are a number of overlaps between these models since this typology represents the continuum of system re-design programmes being implemented across the country, rather than discrete categories.

Conclusion Implementing change in urgent and emergency care services is a complex process, guided by local as well as national considerations, resources and motivations. The results of this study will inform national and regional healthcare system planning on urgent and emergency care with the goal of increasing efficiency and improving performance.