HealthGrades study examines mortality rates for patients entering hospitals through emergency departments

HealthGradesJun 23 2010

The quality of emergency medical care at the nation's hospitals varies widely - both individually and by state - according to a new HealthGrades study released today that, for the first time, examines mortality rates for patients entering hospitals through emergency departments.

The first annual HealthGrades Emergency Medicine in American Hospitals 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 over the years 2006 through 2008 at a faster rate than all other hospitals, 16% compared with 10%.

The first-annual analysis is based on risk-adjusted mortality outcomes for patients admitted through the emergency department for eleven of the most common life-threatening diagnoses in the Medicare population. If all hospitals performed at the level of the top 5%, 118,014 individuals could have potentially survived their emergency hospitalization.

Hospitals in the top 5% were identified this morning on www.healthgrades.com as recipients of the HealthGrades 2010 Emergency Medicine Excellence Award - 255 in total.

Annually, 119 million individuals visit an emergency department, but the number of emergency departments themselves has been decreasing, leading to overcrowding and significant challenges for the hospitals that operate them, according to the Centers for Disease Control and Prevention (CDC).

"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, quoting a recent CDC report. "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."

The most common causes for admission through the emergency department by Medicare patients over the three years studied were pneumonia, chronic obstructive pulmonary disease and sepsis. The highest inhospital mortality rates were among patients with a primary diagnosis of sepsis, respiratory failure or heart attack.

The eleven conditions examined in the study are:
•Bowel obstruction
•Chronic obstructive pulmonary disease
•Diabetic acidosis and coma
•Gastrointestinal bleed
•Heart attack
•Pancreatitis
•Pneumonia
•Pulmonary Embolism
•Respiratory Failure
•Sepsis
•Stroke

State Trends
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 eleven conditions studied.

More than half of 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 eleven conditions studied, Rhode Island, Delaware and Connecticut had the highest percentage of admissions through the emergency department, all between 86% and 89%, while South Dakota, Nebraska and Kansas had the lowest percentage of admissions through the emergency department (49%, 51% and 58%, respectively).