Researchers at University of California San Francisco recently released data demonstrating that when an emergency department closes, the effects can be far-reaching. The study examined 16 million emergency admissions in California between 1999 and 2010.
According to the results, patients who were admitted to a hospital in an area where an ED had recently closed had a 5 percent higher chance of dying compared to patients admitted to hospitals that were not located near recently closed EDs.
Those odds were even greater for patients with certain conditions where time to treat is critical, including:
- Heart attack — 15 percent greater odds
- Stroke — 10 percent greater odds
- Sepsis — 8 percent greater odds
The study is especially timely, the researchers noted, because EDs have been closing nationwide, despite an increase in the number of patients being treated.
During the 14-year period between 1996 and 2009, the number of available EDs dropped by 6 percent to 4,594, while the annual number of emergency department visits grew by an amazing 51 percent. According to the CDC, about 130 million people in the U.S. visit EDs each year.
Even those living in areas where EDs have not closed are feeling the impact, thanks to longer wait times and more crowding in their own local emergency departments, the researchers noted.
For their study, the researchers used data from the California Office of Statewide Health Planning and Development's Hospital Annual Utilization Data files to examine inpatient mortality rates for hospitals located in areas where EDs had closed between 1999 and 2010. During that time period, 48 EDs closed statewide.
What they found was that closures of local EDs had an impact on almost 25 percent of hospital admissions that occurred during the study period. While concerning, the results were not entirely unexpected; previous research has shown a correlation between mortality rates and longer travel times and wait times at overcrowded departments.
The authors also noted that wait times, crowding and distance issues may cause some patients to postpone seeking emergency care, which could also have an impact on mortality and morbidity.
"This association persisted whether we considered ED closures as affecting all future nearby admissions or only those occurring in the subsequent two years," the authors wrote.
The researchers warned one impact of ED closures could be reduced access to care in communities that are already considered vulnerable, including those with significant numbers of low-income and minority patients.
"These results suggest that ED closures have ripple effects on patient outcomes that should be considered when health systems and policymakers decide how to regulate ED closures," they noted.
