Closed ERs May Impact Patient Mortality

SAN FRANCISCO — Patients admitted to a hospital located near another hospital with a closed emergency department have a greater chance of dying, according to a California study published in the August issue of Health Affairs.
Researchers believe that the closure of emergency departments puts pressure on nearby ERs as well as patients. This could be due to increased travel time to farther emergency departments, as well as increased wait times or crowding in ERs with bigger populations.
“The shrinking number of emergency departments combined with a growth in emergency patients is having a demonstrably dangerous effect on the people of California,” said study author Renee Hsia, MD, FACEP, in a statement issued by the American College of Emergency Physicians. “Furthermore, emergency departments and trauma centers — which often experience greater financial pressures than their parent hospitals overall — are more likely to close at hospitals with negative profit margins. Therefore, ER closures may widen disparities by further reducing access to care in communities that are already characterized by having vulnerable patients and underpaid hospitals.”

Between 1999 and 2010, 48 emergency departments closed in California, according to the study. During that time, more than 16 million patients were admitted to California hospitals from the emergency department and one-quarter of them were near a recently closed ER. The odds of inpatient mortality for admitted patients in the vicinity of other ER closures were 5 percent higher than patients who were admitted in areas where no emergency department had closed. The odds of mortality increased by 10 percent for non-elderly adults; 15 percent for patients with acute myocardial infarction; 10 percent for patients with a stroke; and 8 percent for patients with sepsis.

“Emergency department closures have ripple effects on patient outcomes that should be considered when health systems and policy makers decide how to regulate ER closures,” Hsia said. “As it stands now, the people who are most put at risk are those who are most vulnerable — the poor, the underinsured and the very sick.”
Meanwhile, a study published less than a month before the California study claims that the odds of surviving a life-threatening illness or injury are better if the patient is treated at a busy emergency department versus one that handles fewer patients. The study published July 17 in Annals of Emergency Medicine revealed that when 17.5 million emergency patients were treated at nearly 3,000 hospitals in the U.S., the overall risk of death in the hospital was 10 percent lower among those who initially went to the busiest ERs.
“It’s too early to say that based on these results, patients and first responders should change their decision about which hospital to choose in an emergency,” said the study’s lead author, Dr. Keith Kocher, an assistant professor of emergency medicine at the University of Michigan Medical School.