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ER closures raise deaths at nearby hospitals

By Roni Caryn Rabin, Kaiser Health News
updated 12:47 PM EDT, Tue August 5, 2014
Emergency room closures increase the travel time to an ER, exacerbate crowding and prolong waiting times for care.
Emergency room closures increase the travel time to an ER, exacerbate crowding and prolong waiting times for care.
STORY HIGHLIGHTS
  • 6% of the nation's emergency rooms have closed their doors in recent years
  • Many closed ERs used to serve poor inner-city and rural communities
  • Risk of death increased 10% for those under 65 affected by ER closure

(KHN.com) -- 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 impact 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 Monday in the August issue of the journal Health Affairs.

"Emergency department closures generally happen in vulnerable communities, but their ripple effects extend to other hospitals," said the senior author, Dr. Renee Y. Hsia, an associate professor in the department of emergency medicine and the Institute of Health Policy Studies at the University of California, San Francisco.

While many people hearing about an emergency department closing at a hospital that is not where they normally would go may feel relief , Hsia said, "It's important for people to know that it still does affect them."

The researchers used data from the California Office of Statewide Health Planning and Development as well as 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 patients at other hospitals. The increase in the risk of death for affected adults under 65 was even greater: their risk of dying in the hospital increased by 10% compared with similar patients who were not affected by a closure.

And heart attack, stroke and sepsis patients faced a 15% greater risk of dying in the hospital if there had been a closure nearby, when 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.

"An important part of the puzzle is which hospitals are closing down: they're the ones located in underserved areas with poorer populations," noted Dr. Rebecca Parker, a member of the board of directors of the American College of Emergency Physicians, who was not involved in the study.

Meanwhile, she said, the need for emergency care will inevitably increase as the baby boom generation ages. "This is something we need to plan for," she said.

The number of emergency rooms nationwide dropped between 1996 and 2009 from 4,884 to 4,594, while 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.

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