If all emergency patients received the kind of care that the busiest emergency centers give, 24,000 fewer people would die each year, new research suggests.
A new study shows that patients admitted to a hospital after an emergency have a 10 percent lower chance of dying if they go to one of the nation’s busiest emergency departments, compared to the least busy.
The risk of dying differed even more for patients with potentially fatal, time-sensitive conditions. People with sepsis had a 26 percent lower death rate at the busiest emergency centers compared with the least busy, even after researchers adjusted for a range of patient and hospital characteristics.
For lung failure patients, the difference was 22 percent. Even heart attack death rates differed.
Researchers analyzed data from the Nationwide Inpatient Sample database compiled by the Agency for Healthcare Research and Quality on 17.5 million emergency patients treated at nearly 3,000 hospitals.
The study, published in the Annals of Emergency Medicine, calculates that if all emergency patients received the kind of care that the busiest emergency centers give, 24,000 fewer people would die each year. But it also notes that people having an emergency should still seek the closest hospital or call 911.
ERs perform differently
“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,” says lead author Keith Kocher, a University of Michigan Health Systems emergency physician. “But the bottom line is that emergency departments and hospitals perform differently, there really are differences in care and they matter.”
This is the first time a relationship has been shown on a national, broad-based scale between the volume of emergency patients seen at a hospital and the chance those patients will survive their hospital stay.
With half of all hospital inpatients now entering via the emergency department, data and lessons from the best-performing hospitals could improve patients’ chances of leaving any hospital alive. It could also help guide the development of regional systems for emergency care, and specific measures of emergency care quality that could be used to rate hospitals and spur them to perform better.
8 high-risk conditions
In addition to survival for all patients admitted to the hospital from the emergency department, the researchers focused on eight high-risk, time-critical conditions: Pneumonia, congestive heart failure, sepsis, the type of heart attack known as an acute myocardial infarction, stroke, respiratory failure, gastrointestinal bleeding, and acute respiratory failure.
All require emergency providers to use a certain level of diagnostic skill and technology, and successful treatment depends on the ability of emergency and inpatient teams to deliver specialized treatment. All carry a death risk of at least 3 percent, and rank among the top 25 reasons emergency patients get admitted to a hospital.
For instance, sepsis, a body-wide crisis sparked by uncontrolled infection, requires careful diagnosis, rapid deployment of antibiotics, blood pressure support, and constant monitoring.
The team looked at patients who sought emergency care between 2005 and 2009, and excluded those transferred to another emergency department or hospital, those admitted to observation units, and those seen at hospitals with less than 1,000 emergency patients admitted a year. They looked at deaths during the first two days of hospitalization, and during the entire hospitalization.
Practice makes perfect
The findings support earlier research that finds the higher the volume, or number, of patients a center treats, the better the outcomes—even after adjusting for complicating factors.
Those studies have led to recommendations that patients in need of certain operations should choose to go only to the highest-volume surgeons and hospitals. But emergency patients often don’t make a choice in where they get their care—either due to great differences in distance, or the fact that an emergency medical team makes the choice in the ambulance.
So the survival effect in emergency care may be due to many things—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. Kocher and colleagues adjusted for these factors as much as possible before calculating survival rates.
Their results don’t give insights into why the differences in survival occur—but for the first time, they show that they occur, so that further research can probe deeper.
“The take-home message for patients is that you should still call 911 or seek the closest emergency care, because you don’t know exactly what you’re experiencing,” says Kocher, an assistant professor of emergency medicine.
“What makes one hospital better than another is still a black box, and emergency medicine is still in its infancy in terms of figuring that out. For those who study and want to improve emergency care, and post-emergency care, we hope these findings will inform the way we identify conditions in the pre-hospital setting, where we send patients, and what we do once they arrive at the emergency department and we admit them to an inpatient bed.”
Researchers from University of Michigan, Harvard Medical School, University of Washington, and Kaiser Permanente Research contributed to the study.
Source: University of Michigan