ED closures may have deadly ripple effects, study finds

When a hospital emergency department closes its doors, the ripple effect within the surrounding community may be deadly, according to a new study looking at the effect of ED closures in California. Inpatients admitted through emergency rooms in that state were more likely to die in the hospital in communities where a neighboring ED had gone out of business.

Policies that ensure patients in vulnerable neighborhoods have adequate access to emergency care should be considered before allowing a closure, the researchers suggest.

Overall, there was 5% increase in the odds of an inpatient death at hospitals in areas where a neighboring emergency department had terminated service, according to the study published this month in Health Affairs. The closing of one ED potentially leads to longer wait times and overcrowding at other hospitals operating within the same service area, which has a potentially negative effect on patient outcomes, the authors wrote.

The study also found the odds of a patient dying in the hospital increased for specific conditions. There was 8% increased risk of death among inpatients with sepsis, a 10% increased risk among stroke patients and a 15% increased risk among patients with acute myocardial infarction. Patients with time-sensitive conditions are more prone to worse outcomes when needed medical attention is delayed, study authors said.

“It may be time to reassess the extent to which market forces are allowed to dictate (emergency department) closures and access,” wrote researchers from Harvard Medical School, the Ecologic Institute in San Mateo, Calif., and the University of California at San Francisco. They used data from the California Office of Statewide Health Planning and Development to look at all emergency department closures in California between 1999 and 2010 and then analyzed deaths among inpatients admitted through the ED during the same time period.

Though the study focused specifically on California hospitals, the researchers say the findings point to a larger national trend. Between 1996 and 2009 the number of emergency departments nationwide decreased by 6%, with nearly 300 closures. But ED visits increased by 51%, from 90.3 million to 136 million, during the same period.

“Regulatory interventions can be difficult to enact and implement,” the authors concluded. “Nonetheless … our findings indicate that policies such as requiring a hospital to show that surrounding communities would retain adequate access to emergency care before allowing it to close an ED could save lives and reduce disparities.”

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