Emergency Department Hospitalization Volume and Mortality in the United States

Kocher, Keith E.; Haggins, Adrianne; Sabbatini, Amber K.; Sauser, Kori; Sharp, Adam L.

doi:10.1016/j.annemergmed.2014.06.008

Cited by 52 publications

(41 citation statements)

References 34 publications

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“…Three previous studies have reported lower mortality in hospitals that treat more sepsis patients, but each of these studies excluded transferred patients. 6, 12, 13 Whereas these studies compare sepsis outcomes between patients who initially present to high-volume hospitals compared to those who present to low-volume hospitals 26 , our analysis compares outcomes between those who are transferred to those who aren’t transferred, regardless of the characteristics of the index hospital.…”

Section: Discussionmentioning

confidence: 99%

“…4 Unfortunately, this outcome improvement has not completely extended to low-volume EDs, where sepsis mortality can be up to 38% higher than in high-volume EDs. 6 …”

Section: Introductionmentioning

confidence: 99%

“…Regionalization is the practice of transferring patients to higher volume hospitals, and it has been shown to improve outcomes in trauma, myocardial infarction, and ischemic stroke. 7-11 Care in high-volume centers has been associated with increased survival in sepsis as well 6, 12, 13 , so regionalization could narrow the sepsis survival gap between high-volume and low-volume centers by improving the delivery of life-saving interventions. However, the role of regionalization in changing sepsis survival for those who present to low-volume EDs is less clear.…”

Section: Introductionmentioning

confidence: 99%

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Inter-hospital transfer is associated with increased mortality and costs in severe sepsis and septic shock: An instrumental variables approach

Mohr

Harland

Shane

et al. 2016

Journal of Critical Care

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Purpose The objective of this study was to evaluate the impact of regionalization on sepsis survival, to describe the role of inter-hospital transfer in rural sepsis care, and to measure the cost of inter-hospital transfer in a predominantly rural state. Materials and Methods Observational case-control study using statewide administrative claims data from 2005-2014 in a predominantly rural Midwestern state. Mortality and marginal costs were estimated with multivariable generalized estimating equations (GEE) models and with instrumental variables models. Results A total of 18,246 patients were included, of which 59% were transferred between hospitals. Transferred patients had higher mortality and longer hospital length-of-stay than non-transferred patients. Using a multivariable GEE model to adjust for potentially confounding factors, inter-hospital transfer was associated with increased mortality (aOR 1.7, 95%CI 1.5 – 1.9). Using an instrumental variables model, transfer was associated with a 9.2% increased risk of death. Transfer was associated with additional costs of $6,897 (95%CI $5,769-8,024). Even when limiting to only those patients who received care in the largest hospitals, transfer was still associated with $5,167 (95%CI $3,696-6,638) in additional cost. Conclusions The majority of rural sepsis patients are transferred, and these transferred patients have higher mortality and significantly increased cost of care.

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Section: Discussionmentioning

confidence: 99%

“…4 Unfortunately, this outcome improvement has not completely extended to low-volume EDs, where sepsis mortality can be up to 38% higher than in high-volume EDs. 6 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inter-hospital transfer is associated with increased mortality and costs in severe sepsis and septic shock: An instrumental variables approach

Mohr

Harland

Shane

et al. 2016

Journal of Critical Care

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“…Die Ressourcen auf die Diagnosesicherung eines isolierten Leitsymptoms zu fokussieren, kann eine falsche Sicherheit vortäuschen. Aktuelle Analysen belegen eine höhere Versorgungsqualität und eine damit verbundene geringere Sterblichkeit von betroffenen Patienten in großen interdisziplinären Notfallzentren mit hohen Patientenzahlen [32].…”

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Chest Pain Units oder Chest-Pain-Algorithmus?

Christ

Dormann

Enk

et al. 2014

Med Klin Intensivmed Notfmed

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A working group of the German Society of Cardiology published recommendations for infrastructure, equipment and organisation of chest pain units in Germany, which should be separated from the ED of hospitals and be under the leadership of a cardiologist. A symptom-based decision for acute care would be preferable if all differential diagnoses of diseases could be managed by one medical specialty: However, all four main symptoms of patients with acute MI (chest pain, acute dyspnea, abdominal pain, dizziness) are also caused by diseases of different specialties. Evaluation and treatment of acute chest pain by representatives of one specialty would lead to over- or undertreatment of affected patients. Therefore we suggest a multidisciplinary evaluation of patients with acute chest pain including representatives of emergency and critical care physicians, cardiologists, internists, geriatricians, family physicians, premedics and emergency nurses. Definition of key indicators of performance and institutionalized feedback will help to further improve quality of care.

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“…[5,6] In the ED, higher volumes have been associated with lower in-hospital death in multiple conditions (e.g., pneumonia, heart failure, sepsis, stroke, respiratory failure, gastrointestinal haemorrhage, renal failure). [7] These conditions have high associated acute and sub-acute mortality compared to AFF, which is associated with long-term comorbidity (e.g., stroke, heart failure) and longer-term mortality. To our knowledge, the relationships between ED volume and outcomes for AFF have not been explored.…”

Section: Introductionmentioning

confidence: 99%

Volume Matters: Improved Outcomes for Patients Presenting to High-Volume Emergency Departments with Atrial Flutter and Fibrillation

et al. 2016

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ObjectivesClinical familiarity plays a role in health outcomes; the relationship between emergency department (ED) volume and outcomes for atrial fibrillation and flutter (AFF) are not clear. We compared ED presentation outcomes for AFF between high (HV) and low volume (LV) EDs in Alberta, Canada.Methods45,372 AFF presentations for patients aged ≥ 35 years from all 104 EDs in Alberta during 1999 to 2011 using administrative health databases formed a retrospective cohort. EDs were grouped by annual AFF volume: 11 high (>100 presentations) or 93 low (≤100 presentations). Outcomes included hospital admission rate, return to ED for AFF within 30 and 90 days, and death within 30 and 90 days. Analyses included statistical tests and mixed effects modeling.ResultsMean age at ED presentation was 69.8 years (52% male). HV ED presentations were associated with lower admissions (adjusted odds ratio [aOR] = 0.68, 95% confidence interval [CI] 0.64, 0.72; p-value [p]<0.001), ED returns at 90 (aOR = 0.81, 95% CI 0.73, 0.90; p<0.001) days, and a higher likelihood of specialist visits at 30 (aOR = 1.81, 95% CI 1.68, 1.94; p<0.001) and 90 (aOR = 1.82, 95% CI 1.76, 2.03; p<0.001) days. For admitted patients, there were fewer returns to HV EDs at 30 (aOR = 0.37, 95% CI 0.15, 0.87; p = 0.02) and 90 (aOR = 0.48, 95% CI 0.26, 0.89; p = 0.02) days after hospital discharge. There was no difference in death between the two groups.ConclusionsAFF patients presenting to HV EDs experienced fewer admissions and AFF ED revisit and higher specialist referrals compared to LV EDs.

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Emergency Department Hospitalization Volume and Mortality in the United States

Cited by 52 publications

References 34 publications

Inter-hospital transfer is associated with increased mortality and costs in severe sepsis and septic shock: An instrumental variables approach

Inter-hospital transfer is associated with increased mortality and costs in severe sepsis and septic shock: An instrumental variables approach

Chest Pain Units oder Chest-Pain-Algorithmus?

Volume Matters: Improved Outcomes for Patients Presenting to High-Volume Emergency Departments with Atrial Flutter and Fibrillation

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