Busier hospitals are safer for patients (Wired UK)


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Busier emergency departments in US hospitals result in better
outcomes for patients, according to a new study that analysed
almost 20 million hospital admissions between 2005 and 2009.

The research into emergency departments, the American equivalent
of accident and emergency (A&E) services in the UK, could hold
lessons for the NHS, which is controversially downgrading hospitals
in parts of the country.

Those closures, for example in north-west London where four out
of nine hospitals are
being downgraded under a scheme called ‘Shaping a Healthier
Future’
, are partly motivated by evidence that fewer but higher
volume hospitals are safer for patients, an argument further backed
by this latest research.

Published in the Annals of Emergency Medicine, the
study from the University of Michigan analysed data from a database
called the Nationwide Inpatient Sample, which contains information
about hospital discharges.

The researchers found that the poorest performing emergency
departments were in general also those with the fewest inpatients.
Or in other words, the likelihood of dying fell when the volume of
people going to the hospital rose.

The study looked at eight different illnesses, chosen for being
high risk, including pneumonia, sepsis, stroke and respiratory
failure. The analysis involved 17.5 million cases from almost 3,000
hospitals.

“Our analysis demonstrated a positive correlation between
higher-volume emergency departments and improved patient outcomes
for early 2-day and for overall inpatient mortality,” the authors
write in the paper.

There are a number of reasons why this correlation might exist.
One is that “practice makes perfect”, which is broadly that the
more patients a hospital sees, the more efficient its care will be
and the more experience its doctors and nurses will have.

A competing explanation is that the reason a hospital is good is
primarily because of good resources, and that better-performing
hospitals then attract higher volumes of patients. This “selective
referral” argument basically says that the volume follows quality,
not the other way around.

“Teasing apart the causes of this relationship [between volume
and quality] is critical,” write the authors.

But it’s this difference in interpretation that really gets to
the core over the controversy about the effective closures of
A&E departments — while one side says we need to consolidate,
the other points to costly re-organisations of the NHS like that carried out by the
Coalition
and says we need better funding.

Digging down into what really makes hospitals perform better is
crucial to informing that debate.

What makes one hospital better than another is still a
black box, and emergency medicine is still in its infancy in terms
of figuring that out. For those who study and want to improve
emergency care, and post-emergency care, we hope these findings
will inform the way we identify conditions in the pre-hospital
setting, where we send patients, and what we do once they arrive at
the emergency department and we admit them to an inpatient bed,”
said lead author Keith Kocher in a press
release.

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Source: wired.co.uk
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