Crowded ERs Linked to Health Hazards

High-traffic in hospital Emergency Departments (ED) is linked to increased patient death risks and costs, according to an emerging study.

The retrospective, population-based study confirmed that mortality risks increased with the increase in activity at EDs, said MedPage Today. For instance, those patients who were seen when EDs were very full, and when ambulances had to be turned away, experienced a five percent increased risk of death prior to discharge than patients admitted at other times. Some of those same patients also experienced significantly greater hospital stays and costs.

The study was conducted by Benjamin Sun, MD, MPP, of Oregon Health and Science University in Portland, Oregon; appears online in the Annals of Emergency Medicine; and was based on a review of California hospital discharge and ambulance diversion data, said MedPage Today.

“Our study provides additional evidence that ED crowding is a marker for worse care for all ED patients who might require hospital admission,” the group wrote, noting that their study “strengthens the argument to end the practice of ED boarding,” according to MedPage Today. ED Boarding is the practice of keeping patients in hospital EDs until a bed becomes available. Smaller studies have suggested similar patient risks.

One potential reason presented by the researchers involved delays in necessary care for time-critical conditions, including heart attacks and pneumonia, said the researcher, including that “continuity of care in the ED may be compromised by frequent nursing and physician shift changes, and ED priority on evaluating new patients may divert attention from ongoing care of boarded patients,” they added, according to MedPage Today.

The San Francisco Gate pointed out that larger minority groups were found to be disproportionately affected by ED overcrowding, which makes those hospitals likelier to divert ambulance congestion elsewhere. In fact the study revealed that those hospitals servicing the largest percentage of minority patients were turning away ambulances at a rate that was high as four times greater than those facilities serving the smallest number of minorities, the SF Gate noted.

This type of diversion can lead to both delayed care and poor health results, noted the SF Gate and includes patents without primary-care services that could keep them from receiving hospital care as well as hospitals overwhelmed with poorer patients who need better emergency management. All of this is exacerbated in areas with greater minority populations. “Diversion originally was created for patient safety; it was created as a safety valve,” Dr. Renee Hsia, lead author of the study and assistant professor of emergency medicine at UCSF, told the SF Gate. “What diversion shows is that the system is not prepared to provide the care it was designed to provide,” Hsia, who is also an attending physician in San Francisco General Hospital’s ED, added.

Jan Emerson-Shea, spokeswoman for the California Hospital Association, told the SF Gate that overcrowding can affect all patients, not just minorities and those who live in areas that do not divert ambulances. “If another hospital is crowded,” she said, “they may be going to go to your ER.”

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