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Emergency room closures Increase risk of death, study shows

Between 1999 and 2010, 48 emergency departments closed in California

Patients who were admitted to hospitals in the vicinity of a hospital that had closed its emergency department had a 5% greater odds of inpatient mortality than patients admitted to unaffected hospitals, according to a study by a UCSF doctor.

The risk of death was more pronounced for non-elderly patients and patients with time-sensitive conditions such as acute myocardial infarction (AMI or heart attack), stroke and sepsis.

The results of the California study are published in the August issue of Health Affairs ("California Emergency Department Closures Are Associated with Increased Inpatient Mortality at Nearby Hospitals") http://content.healthaffairs.org/content/33/8/1323.abstract.

"The shrinking number of emergency departments combined with a growth in emergency patients is having a demonstrably dangerous effect on the people of California," said senior study author Dr. Renee Hsia of the UC San Francisco.

"Furthermore, emergency departments and trauma centers, which often experience greater financial pressures than their parent hospitals overall, are more likely to close at hospitals with negative profit margins," Hsia states in her article. "Therefore, ER closures may widen disparities by further reducing access to care in communities that are already characterized by having vulnerable patients and underpaid hospitals."

Between 1999 and 2010, 48 emergency departments closed in California. During that time, 16,246.892 patients were admitted to California hospitals from the emergency department, one-quarter of them near a recently closed ER. Patients admitted to the hospital in the geographic vicinity of other emergency department closures had 5% higher odds of inpatient mortality than patients who were admitted in areas where no emergency department had closed.

Odds of morality increased by 10% for non-elderly adults, by 15% for patients with AMI, by 10% for patients with stroke and by 8% for patients with sepsis.

Researchers speculate that the closure of emergency departments increases pressure on surrounding emergency departments as well as on patients who depend on them. The increased mortality may be attributed to increased travel time to farther emergency departments as well as increased wait times or crowding in ERs with bigger populations dependent on them.

"Emergency department closures have ripple effects on patient outcomes that should be considered when health systems and policy makers decide how to regulate ER closures," Hsia said. "As it stands now, the people who are most put at risk are those who are most vulnerable, the poor, the underinsured and the very sick."

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