title: Is emergency department closure resulting in increased distance to the nearest emergency department associated with increased inpatient mortality?
abstract: OBJECTIVE
  We seek to determine whether patients living in areas affected by emergency department (ED) closure, with subsequent increased distance to the nearest ED, have a higher risk of inpatient death from time-sensitive conditions.
  
  
  METHODS
  Using the California Office of Statewide Health and Planning Development database, we performed a nonconcurrent cohort study of hospital admissions in California between 1999 and 2009 for patients admitted for acute myocardial infarction, stroke, sepsis and asthma or chronic obstructive pulmonary disease. We used generalized linear mixed-effects models comparing adjusted inpatient mortality for patients experiencing increased distance to the nearest ED versus no change in distance.
  
  
  RESULTS
  Of 785,385 patient admissions, 67,577 (8.6%) experienced an increase in distance to ED care because of an ED closure. The median change for patients experiencing an increase in distance to the nearest ED was only 0.8 miles, with a range of 0.1 to 33.4 miles. Patients with an increase did not have a significantly higher mortality (adjusted odds ratio 1.04; 95% confidence interval 0.99 to 1.09). In subgroups, we also observed no statistically significant differences in adjusted mortality among patients with acute myocardial infarction, stroke, asthma or chronic obstructive pulmonary disease, and sepsis. We did not observe any significant variations in mortality for time-sensitive conditions in sensitivity analyses that incorporated a lag effect of time after change in distance, allowance for a larger affected population, or removal of ST-segment elevation myocardial infarction from the acute myocardial infarction subgroup.
  
  
  CONCLUSIONS
  In this large population-based sample, less than 10% of the patients experienced an increase in distance to the nearest ED, and of that group, the majority had less than a 1-mile increase. These small increased distances to the nearest ED were not associated with higher inpatient mortality among time-sensitive conditions.
authors.affiliation: Department of Emergency Medicine, University of California San Francisco, San Francisco, CA; San Francisco General Hospital, San Francisco, CA.
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Hsia
authors.forename: Hemal K
authors.initials: HK
authors.lastname: Kanzaria
authors.forename: Tanja
authors.initials: T
authors.lastname: Srebotnjak
authors.forename: Judy
authors.initials: J
authors.lastname: Maselli
authors.forename: Charles
authors.initials: C
authors.lastname: McCulloch
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Auerbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000401:mortality / Q000628:therapy; D002140:California / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006271:Health Facility Closure / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy; D018805:Sepsis / Q000401:mortality / Q000628:therapy; D020521:Stroke / Q000401:mortality / Q000628:therapy; D055815:Young Adult