The quality of emergency medical care at the nation’s hospitals varies widely—both individually and by state—according to a new HealthGrades study that, for the first time, examines mortality rates for patients entering hospitals through emergency departments.
The study examined more than 5 million Medicare records of patients admitted through the emergency department of 4,907 hospitals from 2006 to 2008 and identified hospitals that performed in the top 5% in the nation in emergency medicine.
Comparing the group of hospitals in the top 5% with all others, the study found that the group had a 39% lower risk-adjusted mortality rate. These top-performing hospitals improved their outcomes between 2006 and 2008 at a faster rate than all other hospitals—16% compared to 10%.
The analysis is based on risk-adjusted mortality outcomes for patients admitted through the emergency department for 11 of the most common life-threatening diagnoses in the Medicare population. The most common causes of admission through the emergency department by Medicare patients over the 3 years studied were pneumonia, chronic obstructive pulmonary disease , and sepsis. The highest in-hospital mortality rates were among patients with a primary diagnosis of sepsis, respiratory failure, or heart attack.
According to the study, if all hospitals performed at the level of the top 5%, 118,014 individuals potentially could have survived their emergency hospitalization.
“Half of hospital admissions now begin with hospital emergency departments, up from 36% in 1996,” said Rick May, MD, a vice president with HealthGrades and co-author of the study. “With more individuals expected to visit emergency departments, this HealthGrades study should prove to be a valuable resource for both hospitals and patients in that it identifies hospitals that are the nation’s quality leaders in emergency medical care.”
State trends showed that Mississippi, Alabama, and Hawaii had the worst risk-adjusted mortality for patients admitted through the emergency department, while Ohio, Arizona, and Michigan had the lowest for the 11 conditions studies. More than half the hospitals in the top 5% in the nation for emergency medicine were in only five states: Ohio (37), Florida (28), California (27), Michigan (21), and Illinois (19).
For the 11 conditions studied, Rhode Island, Delaware, and Connecticut had the highest percentage of admissions through the emergency department—all between 86% and 89%. South Dakota, Nebraska, and Kansas, however, had the lowest percentage of admissions through the emergency department—49%, 51%, and 58% respectively.