In the 13 years between 1996 and 2009, the number of emergency rooms has dropped more than 6 percent to 4,594, while emergency department (ED) visits have increased by 50 percent to 136.1 million from 90.3 million. And, a new Health Affairs study shows that these ED closures has led to an increase in the number of people admitted to an emergency room who die; specifically, people whose nearby emergency room has closed are at higher risk of death.
In short, ED closures have hurt the quality of care at nearby emergency rooms. Many of the emergency rooms that have closed had served low-income vulnerable communities, people likely to be Black, Hispanic and female, have Medicaid, be uninsured and in poor health. Patients from communities whose EDs have closed often have travel further to get to an emergency room. The nearby EDs who have taken on more patients as a result of ED closures have been operating over capacity, requiring patients to wait longer for treatment and demanding more of their already busy staff.
The study reveals a five percent greater likelihood of patient death in hospitals affected by ED closures than at other hospitals. Patients who had heart attacks, stroke and sepsis had a 15 percent greater likelihood of death than patients at hospitals unaffected by ED closures. Patients admitted with asthma or COPD did not have a greater risk of death.
Emergency rooms are required to take all comers. They cannot turn a patient away for any reason. Back in 2007, the Institute of Medicine described Emergency Departments as “at a breaking point.” And, more have closed since then. The study suggests a closer look at whether we need more Emergency Departments in vulnerable communities and incentives that would keep more Emergency Departments from closing, including higher payment rates. The authors further suggest that “it may be time to reassess the extent to which market forces are allowed to dictate ED closures and access.”
The study looked at more than 16 million ED admissions but only at Emergency Department closures in California. About 12 percent of the US population lives in California, but it is demographically different from the rest of the country, with a much smaller Black population and a much higher non-White population.
Click here for tips on how to choose your emergency room, and here for how to keep your emergency care costs down. Click here for how to plan for a hospital visit, particular an emergency visit.