The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis

Abstract

Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.

An interrupted time-series analysis of the impact of emergency department reconfiguration on regional emergency department trolley numbers in Ireland from 2005 to 2015

“…The full impact of system-level factors, such as service closures, on ED trolley numbers has been largely understudied 30. A study of service reduction in the USA found that only 80% of the predicted ED volume from hospital closures was seen in nearby ED’s 34. Many patients who may have attended an ED previously due to proximity may now decide that they do not need to access emergency care, potentially due to the increased distance 34 46.…”

“…The rate of ED trolley use also varies between hospitals. This can be due to individual hospital features such as bed capacity, but may also be driven by regional factors such as increases in local population need and the closure of nearby ED services 34. It can be hypothesised that when ED services are halted or reduced in one location, nearby hospitals can expect to see pressures on patient flows from the ED to in-patient beds unless capacity is increased in the new destination hospital.…”

“…In Ireland, there is evidence to suggest that the reconfiguration of hospital services has impacted on patterns of patient flow specifically for those presenting with self-harm in the Mid-West 35. EDs that are geographically further from the closed ED would also be expected to be less impacted by an increase in the number of attendances from that hospital 34. To date, these hypotheses have not been tested by using trolley numbers as a signal of overcrowding.…”

“…To date, these hypotheses have not been tested by using trolley numbers as a signal of overcrowding. To reduce the potential for adverse effects caused by the restructuring of services, it is vital to understand where patient volume and possibly overcrowding will increase as a consequence 34…”

The problems of smaller, rural and remote hospitals: Separating facts from fiction

“…This, in turn, leads to overcrowding and stretched services, with worsening of patient outcomes, for resource-intensive services such as emergency medicine and obstetrics. 87,88 Two Harvard studies found that closure of rural hospitals resulted in a 3% rise in 30-day mortality for patients overall and a 5% rise in 1-year mortality for time-sensitive conditions; there was no evidence of any cost savings from closures. 89,90 These findings were mirrored in a study of hospital closures in California, which found an increase in overall mortality, with changes in mortality differing by diagnostic condition.…”