An analysis of US hospitals finds that, compared with the least busy, the busiest emergency departments give the best chance of surviving, especially to patients whose condition is life-threatening.
In the journal Annals of Emergency Medicine, researchers from the University of Michigan (U-M) Medical School report the first national, broad-based analysis of the link between the volume of emergency patients that hospitals treat and the chance those patients will survive their hospital stay.
They discovered that how many patients are admitted to an emergency department (ED) in a year makes a difference to the chances of those patients surviving their stay – especially for the sickest patients.
Overall, emergency patients had a 10% lower chance of dying if they went to one of the busiest EDs than if they went to one of the least busy.
The chance of survival was even greater for patients with life-threatening conditions. For instance, the risk of dying with sepsis was 26% lower at the busiest compared with the least busy EDs, even after taking a range of patient and hospital variables into account.
For patients with lung failure, the chance of dying was 22% lower. The chances of dying differed even for heart attack patients, note the researchers.
The data from the study, which covered 17.5 million patients attending nearly 3,000 hospitals across the US, came from the Nationwide Inpatient Sample database compiled by the Agency for Healthcare Research and Quality.
The researchers analyzed data on patients who had sought emergency care between 2005 and 2009. They did not include patients transferred to another hospital or emergency department, those admitted to observation units, and those attending hospitals that saw fewer than 1,000 emergency patients in a year.
For their analysis, they looked at deaths occurring during the first 2 days of hospitalization and during the whole stay.
Lead author Keith Kocher, assistant professor in Emergency Medicine and an emergency physician with U-M Health System, warns that it is too early, based on these findings, to say that patients and first responders should change which hospital to go to in an emergency:
“But the bottom line is that emergency departments and hospitals perform differently, there really are differences in care and they matter.”
He and his colleagues estimate that if all emergency patients received the kind of treatment delivered by the busiest EDs, 24,000 fewer patients would die each year.
The team did not look at why the differences in survival occur. That is for future studies to probe.
However, Prof. Kocher says the take-home message is in an emergency, patients should still call 911 or go to the closest hospital because they do not know exactly what they are experiencing.
“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,” he says.
The researchers say that with half of hospital patients now coming in through the ED, there is value in sharing the lessons and data from the best-performing hospitals.
In February 2014, Medical News Today learned how a UK study suggested many more lives would be saved if defibrillators were made as common as fire extinguishers. Despite various attempts to raise awareness of their value, public access and understanding of how to use defibrillators in the UK is still low, said the researchers.