ER Openings, Closures Impact Resources for Heart Attack Patients

A new study has found that hospital emergency room closures can adversely affect health outcomes for heart attack patients at neighboring hospitals that are near or at full capacity. Conversely, when a new emergency department opens, health outcomes for patients at those so-called “bystander” hospitals improve.

The national study, believed to be the first to evaluate the impact of emergency department openings and closures on bystander emergency departments, looked specifically at outcomes for heart attack patients. But researchers said the findings have implications for all patients, particularly in communities where inadequate health resources contribute to disproportionately poor health outcomes.

The study, funded by NHLBI, was released in the September issue of Health Affairs.

“A hospital closure or opening impacts the quality of care that the neighboring hospital can provide to its new patient population,” said Dr. Nicole Redmond, medical officer in NHLBI’s Division of Cardiovascular Sciences. “Hospital closures stress the health care infrastructure, especially if the hospital is already caring for a socially and medically complex patient population and working at full capacity. As a result, such closures may inadvertently increase the health disparities that we are trying to mitigate.”

Scientists used Medicare data between 2001 to 2013 to examine treatment and health outcomes for more than 1 million patients across 3,720 hospitals—including in rural areas—that had been affected by the closure or opening of an emergency department. The authors said they focused on heart attacks because of the known benefits of timely treatment.

The primary measures of health outcomes were 30-day, 90-day and 1-year mortality rates, as well as 30-day readmission rates. Researchers also examined if a patient received an angioplasty and/or stent to open a narrowed or blocked blood vessel that supplies blood to the heart—procedures that can be affected by delayed care or constrained hospital resources.

Researchers found that when the closure of an emergency department was particularly onerous—that is, it resulted in an increased travel time of 30 minutes or more to get to another hospital—health outcomes for patients in the bystander hospitals were negative. The 1-year mortality rate for patients in those hospitals increased by 8 percent and the 30-day readmission rate increased by 6 percent. The likelihood of the same patients receiving the cardiac procedure declined by 4 percent.

On the other hand, researchers found that when an emergency department opened and reduced that driving time by at least 30 minutes, the patients in the bystander hospitals experienced a reduction in 1-year mortality by 5 percent. Researchers also found that the likelihood of these patients receiving the cardiac procedure improved by 12 percent.