Nav: Home

Emergency department openings and closures impact resources for heart attack patients

September 04, 2019

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 the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, was released today 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 Nicole Redmond, M.D., Ph.D., M.P.H., a medical officer in the Division of Cardiovascular Sciences at NHLBI. "Hospital closures stress the healthcare 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 one-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 one-year mortality rate for patients in those hospitals increased by 8% and the 30-day readmission rate increased by 6%. The likelihood of the same patients receiving the cardiac procedure declined by 4%.

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 one-year mortality by 5%. Researchers also found that the likelihood of these patients receiving the cardiac procedure improved by 12%.

The findings from the study are significant and sobering, according to Renee Hsia, M.D., the lead study author who also is an emergency physician at Zuckerberg San Francisco General Hospital and Trauma Center and a professor of emergency medicine and health policy at the University of California, San Francisco.

"We now have evidence that hospital closures affect other hospitals, and they do so in different ways," said Hsia. "Hospitals that are already crowded will likely be unable to maintain the same quality when a nearby emergency department closes."

She noted that opening hospitals, specifically in areas of high need, could be a potential way to improve outcomes.

Still, to achieve long-lasting improvements that benefit patients, Hsia said policymakers need to address some of the problems that can occur in a market-driven healthcare system.

"Patients will go to other hospitals when they experience healthcare crises," she said. "It is crucial that we provide solutions that can help equitably serve all Americans."

Emergency Department Closures and Openings: Spillover Effects on Patient Outcomes in Bystander Hospitals. DOI: 10.1377/hlthaff.2019.00125

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

NIH...Turning Discovery Into Health

NIH/National Heart, Lung and Blood Institute

Related Emergency Department Articles:

Checklist for emergency department team's COVID-19 surge
After reviewing the literature on COVID-19 scientific publications the authors developed a checklist to guide emergency departments.
Why is appendicitis not always diagnosed in the emergency department?
A new study examines the factors associated with a potentially missed diagnosis of appendicitis in children and adults in the emergency department.
Providing contraceptive care in the pediatric emergency department
A new study found that two-thirds of female adolescents ages 16-21 seen in a pediatric Emergency Department (ED) were interested in discussing contraception, despite having a high rate of recent visits to a primary care provider.
Low back pain accounts for a third of new emergency department imaging in the US
The use of imaging for the initial evaluation of patients with low back pain in the emergency department (ED) continues to occur at a high rate -- one in three new emergency visits for low back pain in the United States -- according to the American Journal of Roentgenology (AJR).
Emergency department admissions of children for sexual abuse
This study analyzed emergency department admissions of children for sexual abuse between 2010 and 2016 using a nationwide database of emergency visits and US Census Bureau data.
30-day death rates after emergency department visits
Researchers used Medicare data from 2009 to 2016 to see how 30-day death rates associated with emergency department visits have changed.
Preventing smoking -- evidence from urban emergency department patients
A new study from the Prevention Research Center of the Pacific Institute for Research and Evaluation offers a more in-depth understanding of smoking among patients in an urban emergency department.
When a freestanding emergency department comes to town, costs go up
Rather than functioning as substitutes for hospital-based emergency departments, freestanding emergency departments have increased local market spending on emergency care in three of four states' markets where they have entered, according to a new paper by experts at Rice University.
Emoji buttons gauge emergency department sentiments in real time
Simple button terminals stationed around emergency departments featuring 'emoji' reflecting a range of emotions are effective in monitoring doctor and patient sentiments in real time.
Is caregiver depression associated with more emergency department visits by patients with dementia?
An observational study of 663 caregivers and the patients with dementia they care for suggests caregiver depression is associated with increased emergency department visits for their patients.
More Emergency Department News and Emergency Department Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at