Busy Emergency Departments Offer Better Chance of Survival

A new analysis of hospitals in the United States finds that the busiest emergency departments (EDs) present the best chance of surviving, especially to patients whose condition is life-threatening.

Researchers at the University of Michigan (U-M; Ann Arbor, USA) analyzed data from the Nationwide Inpatient Sample (NIS) database on 17.5 million emergency patients treated at nearly 3,000 hospitals across the United States between 2005 and 2009. Not included were patients transferred to another hospital or ED, those admitted to observation units, and those attending hospitals that saw fewer than 1,000 emergency patients a year. The analysis included deaths occurring during the first two days of hospitalization and during the whole stay.

The researchers found that the overall risk of death was 10% lower among those who initially went to the busiest EDs rather than to the least busy ones. The survival difference was even greater for patients with serious, time-sensitive conditions. For example, death rates were 26% lower for sepsis patients and 22% lower for lung failure patients. The finding held even when the researchers accounted for differences in the patients’ health, income level, hospital location, and technology. The study was published on July 17, 2014, in Annals of Emergency Medicine.

“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,” said lead author assistant professor of emergency medicine Keith Kocher, MD. “But the bottom line is that emergency departments and hospitals perform differently, there really are differences in care. If all emergency patients received the kind of care provided at the busiest emergency departments, 24,000 fewer patients would die each year.”

“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. 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,” added Dr. Kocher. “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.”

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