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Press release
Wednesday, September 4, 2019
An NIH-funded study highlights hospitals with high occupancy rates.
A new study has shown that closing hospital emergency rooms can have adverse health effects for heart attack patients in nearby hospitals or at full capacity. Conversely, when opening a new emergency service, the results for the health of patients in these so-called "stay" hospitals improve.
The national study, considered the first to assess the impact of emergency openings and closures on emergencies, focused specifically on outcomes for patients with heart attacks. But the researchers said the findings have implications for all patients, especially in communities where insufficient health resources contribute to disproportionate health outcomes.
The study, funded by the National Institute of the Heart, Lung and Blood (NHLBI), part of the National Institutes of Health, was published today in the September issue of Health Affairs.
"The closing or opening of a hospital is affecting the quality of care that the nearby hospital can provide to its new patient population," said Nicole Redmond, MD, Ph.D. ., MPH, Physician, NHLBI Division of Cardiovascular Sciences. "Hospital closures are straining the health care infrastructure, especially if the hospital already has a socially and medically complex patient population and is working to full capacity. As a result, such closures may inadvertently aggravate the health disparities that we are trying to mitigate. "
Scientists used Medicare data between 2001 and 2013 to examine the treatment and health effects of more than one million patients in 3,720 hospitals, including in rural areas, affected by closure or death. Opening of an emergency service. The authors indicated that they were focusing on heart attacks because of the known benefits of rapid treatment.
The main measures of health outcomes were 30-day, 90-day and one-year mortality rates, as well as 30-day readmission rates. The researchers also examined whether a patient was receiving angioplasty and / or a stent to open a narrowed or blocked blood vessel that was supplying the heart with blood – procedures that could be affected by delayed care or limited hospital resources.
The researchers found that when closing an emergency department was particularly painful, that is, the trip took more than 30 minutes to get to another hospital. The one-year mortality rate for patients in these hospitals increased by 8% and the readmission rate after 30 days by 6%. The likelihood of the same patients undergoing cardiac surgery decreased by 4%.
On the other hand, researchers found that, when an emergency department opened and reduced this driving time to at least 30 minutes, patients in outlying hospitals showed a reduction in 5 year mortality of 5%. The researchers also found that the likelihood of these patients undergoing cardiac surgery increased by 12%.
The results of the study are significant and sobering, according to Renee Hsia, MD, the study's lead author and emergency physician at Zuckerberg General Hospital San Francisco and at the Trauma Center and Professor of Medicine. Emergency and Health Policy at the University of California. , San Francisco.
"We now have evidence that hospital closures affect other hospitals in different ways," said Hsia. "Hospitals already overcrowded will probably not be able to maintain the same quality when a nearby emergency service will close."
She noted that opening hospitals, especially in areas where needs are glaring, could be a way to improve results.
However, to achieve lasting improvements that benefit patients, Dr. Hsia said policymakers need to address issues that may arise in a market-based health system.
"Patients will go to other hospitals in case of a health crisis," she said. "It is crucial that we provide solutions that can help serve all Americans equitably."
Study
Closures and openings in the emergency departments: effects of training on the results for patients in Bystander hospitals. DOI: 10.1377 / hlthaff.2019.00125
About the National Institute of Heart, Lungs and Blood (NHLBI): NHLBI is the world leader in leading and supporting research on heart, lung and blood diseases and sleep disorders that advances scientific knowledge, improves public health and saves lives. For more information, visit http://www.nhlbi.nih.gov.
About the National Institutes of Health (NIH):
The NIH, the country's medical research agency, has 27 institutes and centers and is part of the US Department of Health and Human Services. NIH is the lead federal agency that leads and supports basic, clinical and translational medical research. She studies causes, treatments and cures for common and rare diseases. For more information on NIH and its programs, visit www.nih.gov.
NIH … transforming discovery into health®
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