Emergency departments would do well to tell their potential patient population that smartphone apps featuring which neighborhood ER is the least busy are generally a waste of money.
For patients with the sniffles, this might be useful information — although it is a waste of money and the ER's time for such a minor ailment. Go to an urgent care center. Public service announcements that all ERs sponsor should carry this message.
But when it comes to life-threatening emergencies, hospitals with more ER admissions have better survival rates, according to a recent study.
In the Annals of Emergency Medicine, researchers from the University of Michigan (U-M) Medical School report the first national, broad-based investigation of the link between the number of emergency patients that hospitals treat and the likelihood those people will survive their hospital stay.
These findings result from research of 17.5 million patient visits at nearly 3,000 hospitals. The data analyzed by the research team was from the Nationwide Inpatient Sample database compiled by the Agency for Healthcare Research and Quality.
According to researchers, if all patients visiting ERs received the kind of care given in the busiest ER, 24,000 fewer people would die each year. The authors caution that people with medical emergencies should always go to the nearest hospital or call for help from 911.
Keith Kocher, M.D., MPH, the lead author of the new study and a U-M Health System emergency physician stated: "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, but the result is that emergency departments and hospitals perform differently, there really are differences in care and they matter."
This research is the first study to find a link between ER volumes and quality of care on a national basis.
In the 24 states where Medicaid has not been expanded and even in states where it has, admissions to the hospital from the emergency department contribute to half of all hospital admissions. Kocher thinks the information gained from the hospitals with the busiest EDs could help survival rates for patients in all hospitals, as well as guide the development of regional systems for emergency care.
The U-M researchers studied more than just total patients admitted to hospitals from emergency departments. They zeroed in on eight high-risk, time-critical illnesses. They were:
- Sepsis
- Acute myocardial infarction
- Pneumonia
- Acute respiratory failure
- Stroke
- Gastrointestinal bleeding
- Respiratory failure
- Congestive heart failure
Researchers chose these eight diagnoses as they all need emergency care providers to have a high level of diagnostic ability and technology. Further, successful outcomes depend on the ability of both emergency care providers and inpatient care teams to give specialized treatment. These eight illnesses all rank in the top 25 reasons for emergency patient hospital admissions and all have a fatality risk of at least 3 percent.
Sepsis, for example, causes a crisis throughout the patient's body begun and maintained by an uncontrolled infection. Treatment requires a careful diagnosis, a quick choice of effective antibiotics, ongoing blood pressure support and continuous monitoring.
Researchers looked at patients going to EDs between 2005 and 2009. Excluded from the study were patients transferred in, patients admitted for observation and patients seen at hospital with fewer than 1,000 patients admitted through the ED during the year.
U-M researchers conducted a similar study about surgery with similar results — the more of certain kinds of surgeries a hospital does, the better the outcomes. The surgery study led to recommendations that patients needing particular types of surgeries should only go to high-volume hospitals for those surgeries.
However, Kocher warns that the survival rates in emergency care have many causes: The experience of the diagnosing emergency physicians, the availability of specialists, the skill and staffing levels of emergency and inpatient teams, the technologies available at the hospital, the patients' own health and socioeconomic background, and the location and nature of the hospital."
For now, researchers have established the link between survival and high-volume. The reasons for the differences need further study.
