Busiest emergency departments have lowest mortality rates

Seriously ill patients fare better when admitted through high-volume ERs
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Patients are less likely to die in a hospital if they are admitted through a high-volume emergency department (ED), according to a new study published in Annals of Emergency Medicine.

Researchers examined the association between ED hospitalization volume and mortality rates for common high-risk procedures using data from the Nationwide Inpatient Sample from 2005 to 2009. 

After analyzing about 17.5 million hospital admissions from about 3,000 different hospitals, researchers placed EDs into quintiles based on hospital volume, and found that mortality decreased as volume increased overall for all diagnoses, but importance of volume varied depending on the condition. The conditions were pneumonia, congestive heart failure, sepsis, acute myocardial infarction, stroke, respiratory failure, gastrointestinal bleeding and acute respiratory failure.

Adjusted mortality rates between high-volume EDs and very low-volume EDs ranged from -5.6 percent for sepsis to .2 percent for pneumonia, with an overall difference of .4 percent. The survival difference was even greater for patients with serious, time-sensitive conditions. Death rates were 26 percent lower for sepsis patients and 22 percent lower for lung failure patients who went to the busiest EDs compared to those who went to the least busy ones, according to a study announcement.

Researchers concluded that patients have a lower likelihood of in-hospital death if admitted through a high-volume ED. The authors calculate that if all emergency patients received the kind of care that the busiest emergency centers give, 24,000 fewer people would die each year.

"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," the study's lead author, Keith Kocher, M.D., an assistant professor of emergency medicine at the University of Michigan Medical School, said in the announcement. "But the bottom line is that emergency departments and hospitals perform differently, there really are differences in care and they matter."

To learn more:
- here's the study abstract
- read the announcement

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