For the sickest patients, chances of dying lowest at the busiest ERs

The conventional wisdom holds that if you’re suffering from a medical emergency, you should get to the closest hospital as quickly as possible. But a new study is raising questions about that wisdom.

An analysis of 17.5 million very sick patients admitted to hospitals across the country found that those who went to the busiest emergency departments had a 10 percent lower risk of dying from eight high-risk conditions, compared to those who went to the least busy.

For some serious, life-threatening conditions, the differences were even greater. Sepsis patients had a 26 percent lower death rate at the busiest centers. Lung failure patients had a 22 percent lower death rate.

“When it comes to life-threatening emergencies, this study demonstrates that ‘bigger really is better,'” said Dr. Bruce Adams, chair of emergency medicine at University Hospital and the UT Health Science Center San Antonio, who wasn’t involved in the study.

Adams noted University Hospital would be included in those high-volume centers with some 65,000 patients a year — a number that could grow significantly with the opening of the Sky Tower and a twice-as-large emergency department. Of those patients, 21 percent are levels 1 and 2 — the most seriously ill. Between 25 and 30 percent are admitted to the hospital.

“The doctors, nurses and the Emergency Department team at University Hospital see more seriously ill and injured patients than just about any other hospital in the region,” Adams said. “This daily treatment of the most life-threatening emergencies makes us very good at what we do, backed up by the entire hospital team and medical specialists from the UT Health Science Center.”

The study by University of Michigan researchers, published online this week in the Annals of Emergency Medicine, is the first to show a link between survival and volume on a broad, national scale. And while the authors are cautious about drawing conclusions, saying it’s too soon based on this study alone for patients and first responders to change their decision about where to go in an emergency, the differences were dramatic.

If all those emergency patients got the level of care seen at the busiest emergency centers, the authors projected that 24,000 fewer people a year would die.

The eight conditions included in the study were pneumonia, congestive heart failure, sepsis, acute myocardial infarction, stroke, respiratory failure, gastrointestinal bleeding and acute respiratory failure.

Why the differences? Other research has found that patients undergoing certain kinds of surgeries have better outcomes at centers that do a lot of them — with the highest volumes tied to the best results.

In an accompanying news release, the study’s lead author said the survival differences among emergency patients may be a result of several factors, including the experience of the physicians, the availability of specialists, the skill and staffing levels of the emergency and inpatient teams, available technology and other factors — which the researchers tried to adjust for in examining the data.

 

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