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Outcomes better for high-risk patients in high-volume EDs
Patients with severe emergencies, such as acute MI, had more favorable outcomes when they visited a high-volume ED, according to a study from researchers at the University of Michigan School of Medicine.
One of the researchers, Keith E. Kocher, MD, MPH, assistant professor in the Department of Emergency Medicine at University of Michigan, said that mortality associated with hospital admissions have been studied since the 1990s, but that he wanted to look specifically at ED outcomes.
“This relationship existed in other areas, so I wondered if the same would hold true in emergency care and what we deliver in emergency departments,” he told Cardiology Today.
“The take-home message for me is that where you get your emergency care really does seem to matter in producing different outcomes. Some EDs and affiliated hospitals seem to perform better than others when taking care of very high-risk medical patients.”
The researchers studied data from over 17.5 million cases at nearly 3,000 hospitals between 2005 and 200. All hospitals had at least 1,000 annual admissions and a minimum of 30 disease-specific cases across eight diagnoses, including MI, stroke, HF and sepsis. Hospitals were divided into five groups according to hospitalization volume.
As hospital volume decreased, mortality declined “in a stepwise fashion,” both overall and for each evaluated diagnosis specifically, the reporters wrote.
“There is this association between volume and survival,” Kocher said. “I think this sets up lots of important and pretty interesting questions that need to be figured out. We know that in these types of high-risk emergency conditions, the timeliness of early identification and treatment, the ability to coordinate care, the ability to perhaps involve specialists or perform a particular procedure is important. … Are there factors associated with these higher volume centers that we can identify to explain the difference?”
Kocher said the study could be “characterized as a high-altitude overlook at the landscape,” and is not intended to identify the reasons behind the improvement by volume. Ideally, he said, a clinical trial with enrolled hospitals would be more effective.
He acknowledged the small size as a limitation of the study, and said that grouping nearly 3,000 hospitals into five categories may have masked some lower-volume hospitals that performed well. He also cautioned that patients should not opt to use an ED located further away during an emergency simply due to higher volume. – by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.