Busy is Better: High Volume Emergency Departments Offer the Best Chance for Survival

A recent study has revealed a relationship between the volume of emergency patients that are seen at a hospital and the probability that these patients will survive their stay. It is the first time such a relationship has been shown on a national, broad-based scale. The study supports the opinion that individual hospitals and emergency departments perform differently—and that these differences have a major impact on patient outcomes.

The study was conducted by a team of researchers at the University of Michigan Medical School and reported in the Annals of Emergency Medicine. The team analyzed data from the Nationwide Inpatient Sample database compiled by the Agency for Healthcare Research and Quality. It was gathered on 17.5 million emergency patients who had been treated at 3,000 hospitals across the U.S. The study focused on eight high-risk, time-critical conditions: pneumonia, congestive heart failure, sepsis, acute myocardial infarction, stroke, respiratory failure, gastrointestinal bleeding, and acute respiratory failure. These conditions were selected for several reasons: They require emergency care providers to have significant diagnostic skill and a command of technology. They require specialized treatment. They carry a death risk of at least 3% percent, and they rank among the top 25 reasons that emergency patients are admitted.

Findings from the study suggest that patient volume in an emergency department may correlate with patient survival—especially for patients who suffer life-threatening medical events. The busiest emergency departments fared best in the study with patients who had experienced potentially fatal conditions that required timely medical intervention showing an overall 10% lower chance of dying if they had been treated in one of the busiest emergency departments. Other findings included a 26% lower death rate among patients with sepsis at higher volume emergency centers and a 22% lower death rate among patients with lung failure. Heart attack death rates differed as well.

Researchers concluded that if all emergency patients received the same level of care provided at high volume emergency departments, 24,000 fewer people would die each year.

The researchers in this study attributed the higher survivability rate at the busiest emergency departments to a number of factors, including the availability of experienced diagnosing emergency physicians and specialists, the skill and staffing levels of emergency and inpatient teams, technologies available at the hospital, the patients’ health and socioeconomic background, and the location and nature of the hospital. Further research will be needed to determine the exact reasons for the difference in survival but, for the first time, this study shows that there are differences.

The findings mirror other studies involving surgery patients conducted by University of Michigan Medical School teams, which also demonstrated that patient outcomes are better for those patients treated at higher volume medical centers, even after adjusting for complicating factors.

Half of all hospital inpatients now enter the hospital through the emergency department, so lessons learned from the best performing hospitals could significantly improve patient survival rates and provide a basis for emergency care measures to rate hospitals and improve performance and care quality overall.

To learn and apply critical nursing triage concepts expertly, look into ENA’s Emergency Nursing Triage course, which provides a foundation for triage skills that help nurses intervene with confidence.

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