title: California emergency department closures are associated with increased inpatient mortality at nearby hospitals.
abstract: Between 1996 and 2009 the annual number of emergency department (ED) visits in the United States increased by 51 percent while the number of EDs nationwide decreased by 6 percent, which placed unprecedented strain on the nation's EDs. To investigate the effects of an ED's closing on surrounding communities, we identified all ED closures in California during the period 1999-2010 and examined their association with inpatient mortality rates at nearby hospitals. We found that one-quarter of hospital admissions in this period occurred near an ED closure and that these admissions had 5 percent higher odds of inpatient mortality than admissions not occurring near a closure. This association persisted whether we considered ED closures as affecting all future nearby admissions or only those occurring in the subsequent two years. These results suggest that ED closures have ripple effects on patient outcomes that should be considered when health systems and policy makers decide how to regulate ED closures.
authors.affiliation: Charles Liu is a medical student at Harvard Medical School, in Boston, Massachusetts.
authors.forename: Charles
authors.initials: C
authors.lastname: Liu
authors.affiliation: Tanja Srebotnjak is a senior fellow at the Ecologic Institute, in San Mateo, California.
authors.forename: Tanja
authors.initials: T
authors.lastname: Srebotnjak
authors.affiliation: Renee Y. Hsia (renee.hsia@emergency.ucsf.edu) is an associate professor in the Department of Emergency Medicine and the Institute of Health Policy Studies, University of California, San Francisco.
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Hsia
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006271:Health Facility Closure; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Organization and Delivery of Care
references.citation: Ann Emerg Med. 2012 Dec;60(6):679-686.e3
references.pmid: 22727201
references.citation: Ann Emerg Med. 2012 Dec;60(6):707-715.e4
references.pmid: 23026784
references.citation: Acad Emerg Med. 2006 Nov;13(11):1220-7
references.pmid: 16946281
references.citation: Health Serv Res. 2012 Feb;47(1 Pt 1):188-210
references.pmid: 22091922
references.citation: Ann Emerg Med. 2013 Jun;61(6):605-611.e6
references.pmid: 23218508
references.citation: Ann Emerg Med. 2012 May;59(5):358-65
references.pmid: 22093435
references.citation: Ann Emerg Med. 2010 Jul;56(1):49-51
references.pmid: 20045577
references.citation: Ann Emerg Med. 2000 Jan;35(1):63-8
references.pmid: 10613941
references.citation: Med Care. 2009 Sep;47(9):968-78
references.pmid: 19704354
references.citation: JAMA. 2010 Aug 11;304(6):664-70
references.pmid: 20699458
references.citation: J Emerg Nurs. 2000 Aug;26(4):380-3
references.pmid: 10940852
references.citation: JAMA. 2011 May 18;305(19):1978-85
references.pmid: 21586713
references.citation: JAMA. 2011 Jun 15;305(23):2440-7
references.pmid: 21666277
references.citation: Health Serv Res. 1983 Winter;18(4):551-74
references.pmid: 6199325
references.citation: Am J Public Health. 2010 Aug;100(8):1462-9
references.pmid: 20558800
references.citation: J Trauma. 1991 Jul;31(7):920-5; discussion 925-6
references.pmid: 2072430
references.citation: Adv Data. 1997 Dec 17;(293):1-20
references.pmid: 10182644
references.citation: Geospat Health. 2007 May;1(2):243-53
references.pmid: 18686249
references.citation: Ann Emerg Med. 2003 Jan;41(1):35-44
references.pmid: 12514681
references.citation: Med Care. 1998 Jan;36(1):8-27
references.pmid: 9431328