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ER Closures Raise Death Rates at Nearby Hospitals

Authors report ‘ripple effects’

Emergency patients who are admitted to the hospital are at greater risk of dying if another emergency room at a hospital nearby has closed its doors, a new study of California hospitals has found.

The analysis is believed to be the first to examine the effect that emergency department closures have on the quality of patient care at other hospitals within the same service area.

Six percent of the nation’s emergency rooms have closed their doors in recent years, including many that serve poor inner-city and rural communities. At the same time, the number of emergency visits throughout the country has increased by 51% — a combination of developments that has led to more overcrowding and longer waits for emergency care. The study was published August 4 in Health Affairs.

“Emergency department closures generally happen in vulnerable communities, but their ripple effects extend to other hospitals,” said senior author Dr. Renee Y. Hsia.

The researchers used data from the California Office of Statewide Health Planning and Development and other sources to identify 48 hospitals that closed their emergency departments in that state between 1999 and 2010. They then analyzed inpatient deaths among 16 million adult inpatients admitted through emergency departments during the same period.

They found that 4 million of those admissions were to hospitals located near another emergency department that had closed. Patients at the affected hospitals were more likely than patients at unaffected hospitals to be black, Hispanic, female, and under the age of 65; they were also more likely to be uninsured or on Medicaid, and to be sicker overall.

Even after adjusting for the different patient and hospital characteristics, however, the researchers found that among inpatients at hospitals affected by an emergency room closure, 5% were more likely to die than were patients at other hospitals. The increase in the risk of death for affected adults less than 65 years old was even greater: their risk of dying in the hospital increased by 10% compared with similar patients who were not affected by a closure.

Moreover, patients with heart attack, stroke, or sepsis had a 15% greater risk of dying in the hospital if there had been a closure nearby, compared with similar patients at unaffected hospitals.

The researchers said emergency room closures at nearby facilities may contribute to mortality at other hospitals because they increase the distance and travel time to an emergency room while exacerbating crowding and prolonging waiting times for care. Closures may also cause some patients to postpone seeking care, so that they are in worse shape by the time they arrive at a hospital, Hsia said.

The number of emergency rooms nationwide dropped from 4,884 to 4,594 between 1996 and 2009, whereas the number of emergency department visits increased from 90.3 million in 1996 to 136.1 million in 2009, according to the National Center for Health Statistics.

Sources: Kaiser Health News; August 4, 2014; and Health Affairs; August 2014.

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