A new study has found that hospital emergency room closures can adversely affect health outcomes for heart attack patients at neighboring hospitals that are near or at full capacity. Conversely, when a new emergency department opens, health outcomes for patients at those so-called “bystander” hospitals improve.
The national study, believed to be the first to evaluate the impact of emergency department openings and closures on bystander emergency departments, look specifically at outcomes for heart attack patients. But researchers said the findings have implications for all patients, particularly in communities where inadequate health resources contribute to disproportionately poor health outcomes. The study, funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health, was released today in the September issue of Health Affairs.
“A hospital closure or opening impacts the quality of care that the neighboring hospital; which can provide to its new patient population,” said Nicole Redmond, M.D., Ph.D., M.P.H. “Hospital closures stress the healthcare infrastructure; especially if the hospital is already caring for a socially and medically complex patient population and working at full capacity. As a result, such closures may inadvertently increase the health disparities that they are trying to mitigate.”
Outcomes of heart attack
Scientists used Medicare data between 2001 to 2013 to examine treatment and health outcomes for more than 1 million patients across 3,720 hospitals including in rural areas that had been affected by the closure or opening of an emergency department. The authors said they focused on heart attacks because of the known benefits of timely treatment.
The primary measures of health outcomes were 30-day, 90-day; also one year mortality rates; as well as 30-day readmission rates. Researchers also examined if a patient received an angioplasty; and/or stent to open a narrow or block blood vessel that supplies blood to the heart procedures that can be affect by delay care or constrain hospital resources.
Researchers found that when the closure of an emergency department was particularly onerous that is; it result in an increase travel time of 30 minutes or more to get to another hospital health outcomes; for patients in the bystander hospitals were negative. The one year mortality rate for patients in those hospitals increased by 8% and the 30-day readmission rate increase by 6%. The likelihood of the same patients receiving the cardiac procedure declined by 4%.
The healthcare infrastructure
On the other hand, researchers find that when an the healthcare infrastructure; also reduce that driving time by at least 30 minutes; the patients in the bystander hospitals experience a reduction in one year mortality by 5%. Researchers also find that the likelihood of these patients receiving; the cardiac procedure improve by 12%.
“They now have evidence that hospital closures affect other hospitals; also they do so in different ways,” said Hsia. “Hospitals that are already crowded will likely be unable to maintain the same quality when a nearby emergency department closes.” She note that opening hospitals; specifically in areas of high need; could be a potential way to improve outcomes.
Still, to achieve long-lasting improvements that benefit patients; Hsia said policymakers need to address some of the problems that can occur in a market-driven healthcare system. “Patients will go to other hospitals when they experience healthcare crises,” she said. “It is crucial that we provide solutions that can help equitably serve all Americans.”