- A new study of California hospitals found that if an ER closes down, patients admitted to a nearby hospital are at greater risk of dying. The study is the first of its kind to examine the impact of ER closures on outcomes and patient care.
- Using data from the California Office of Statewide Health Planning and Development, researchers examined 48 hospitals that closed their EDs between 1999 and 2000, then compared that data to inpatient deaths among the 16 million adult inpatients admitted through EDs during that same time. 4 million of those admissions were near a recently-closed ED.
- The study, which adjusted for patient and hospital characteristics, found that inpatients near a recently-closed ED were 5% more likely to die than patients at other hospitals (10% more likely if the patient was over 65). Patients at impacted hospitals were more likely to be uninsured or on Medicaid; more likely to be sicker overall; and more likely to be black, Hispanic, female and under the age of 65.
"Emergency department closures generally happen in vulnerable communities, but their ripple effects extend to other hospitals," said senior author, Dr. Renee Y. Hsia, an associate professor in the department of emergency medicine at the University of California, San Francisco.
Dr. Rebecca Parker, who was not a part of the study, but is a member of the board of directors of the American College of Emergency Physicians, backed Hsia up: "An important part of the puzzle is which hospitals are closing down: they're the ones located in underserved areas with poorer populations."
According to researchers, the closure of nearby EDs contributes to increased mortality rates in a number of ways. Patients may prolong receiving care after a closure, ensuring the advancement of their illness or injury. Closures can also increase travel time to emergency facilities as well as creating over-crowding and extending wait times.
Some industry members call for the study to be compared to an area with more reliable and affordable public transportation than California, isolating the impact of travel time and convenience on mortality.