Busy emergency departments 'offer best chance of survival'
Date: Jul-18-2014 An analysis of US hospitals finds that,
compared with the least busy, the busiest emergency departments give the best chance of surviving,
especially to patients whose condition is life-threatening.
In the journal Annals of Emergency Medicine, researchers from the University of Michigan
(U-M) Medical School report the first national, broad-based analysis of the link between the
volume of emergency patients that hospitals treat and the chance those patients will survive
their hospital stay.
They discovered that how many patients are admitted to an emergency department (ED) in a year
makes a difference to the chances of those patients surviving their stay - especially for the
sickest patients.
Overall, emergency patients had a 10% lower chance of dying if they went to one of the
busiest EDs than if they went to one of the least busy.
Chances of survival even greater for the sickest patients
The chance of survival was even greater for patients with life-threatening conditions. For
instance, the risk of dying with sepsis was 26% lower at the busiest compared with the least busy
EDs, even after taking a range of patient and hospital variables into account.
The study revealed that emergency patients had a 10% lower chance of dying if they went to one of the busiest EDs than if they went to one of the least busy.
For patients with lung failure, the chance of dying was 22% lower. The chances of dying
differed even for heart attack patients, note the researchers.
The data from the study, which covered 17.5 million patients attending nearly 3,000 hospitals
across the US, came from the Nationwide Inpatient Sample database compiled by the Agency for
Healthcare Research and Quality.
The researchers analyzed data on patients who had sought emergency care between 2005 and 2009.
They did not include patients transferred to another hospital or emergency department, those
admitted to observation units, and those attending hospitals that saw fewer than 1,000 emergency
patients in a year.
For their analysis, they looked at deaths occurring during the first 2 days of hospitalization
and during the whole stay.
Lead author Keith Kocher, assistant professor in Emergency Medicine and an emergency physician
with U-M Health System, warns that it is too early, based on these findings, to say that patients
and first responders should change which hospital to go to in an emergency:
"But the bottom line is that emergency departments and hospitals perform differently, there
really are differences in care and they matter."
24,000 fewer deaths per year if all EDs performed as well as the busiest
He and his colleagues estimate that if all emergency patients received the kind of treatment
delivered by the busiest EDs, 24,000 fewer patients would die each year.
The team did not look at why the differences in survival occur. That is for future studies to
probe.
However, Prof. Kocher says the take-home message is in an emergency, patients should still call
911 or go to the closest hospital because they do not know exactly what they are
experiencing.
"What makes one hospital better than another is still a black box, and emergency medicine is
still in its infancy in terms of figuring that out," he says.
The researchers say that with half of hospital patients now coming in through the ED, there is
value in sharing the lessons and data from the best-performing hospitals.
In February 2014, Medical News Today learned how a UK study suggested many more lives
would be saved if defibrillators were made as common as fire
extinguishers. Despite various attempts to raise awareness of their value, public access and
understanding of how to use defibrillators in the UK is still low, said the researchers.
Written by Catharine Paddock PhD
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Courtesy: Medical News Today
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