Nearby ED closures increase risk of inpatient death

Patients admitted to hospital emergency departments (EDs) are at greater risk of death if another nearby ED recently closed, according to a study published in Health Affairs.

Between 1996 and 2009, annual ED visits went up 51 percent, while the number of EDs nationwide dropped 6 percent, straining the remaining EDs' resources, according to the study.

"Emergency department closures generally happen in vulnerable communities, but their ripple effects extend to other hospitals," lead author Renee Y. Hsia, an associate professor in the Department of Emergency Medicine and the Institute of Health Policy Studies at the University of California, San Francisco, told Kaiser Health News. Although it may come as a relief to patients when a neighboring ED closes rather than their own, "it's important for people to know that it still does affect them."

Hsia and her team identified 48 California hospitals that closed their EDs between 1999 and 2010 based on data from the state's Office of Statewide Health Planning and Development and other sources. They then analyzed inpatient mortality within the 16 million adult inpatients admitted through the ED during that period.

Of those admissions, 4 million were in hospitals in close proximity to another with a recently-closed ED, with patients at affected hospitals more likely to be black, Hispanic, female, younger than 65, uninsured, on Medicaid or in worse overall health.

After adjusting for other patient and hospital characteristics, Hsia and her team found that inpatients at hospitals affected by ED closures were 5 percent more likely to die than those at unaffected hospitals. Patients younger than 65 were 10 percent more likely to die in-hospital, according to the study.

Meanwhile, Pittsburgh hospital closures put a strain on local clinics to pick up the slack providing uncompensated care to low-income patients, according to

The study comes as many overcrowded EDs look to redirect patients who could get better service elsewhere, FierceHealthcare previously reported.

To learn more:
- read the study abstract
- here's the KHN article
- read the HealthcareDive article