PhotoIt's fairly well known that if you have the misfortune of being shot, stabbed or otherwise traumatized, you should hope you're taken to a big-city hospital where such wounds are an everyday occurrence. It's called the "practice makes perfect" effect.

Now a new study suggests the same is true of other types of emergencies as well. In other words, your risk of dying from a severe medical emergency is lowest at the busiest emergency rooms. 

In fact, the analysis finds that patients admitted to a hospital after an emergency had a 10% lower chance of dying in the hospital if they initially went to one of the nation's busiest emergency departments, compared with the least busy.

The risk of dying differed even more for patients with potentially fatal, time-sensitive conditions. People with sepsis had a 26% lower death rate at the busiest emergency centers compared with the least busy, even after the researchers adjusted for a range of patient and hospital characteristics. For lung failure patients, the difference was 22%. Even heart attack death rates differed.

24,000 fewer deaths

The new findings, based on national data on 17.5 million emergency patients treated at nearly 3,000 hospitals, appear in an Annals of Emergency Medicine paper by a University of Michigan Medical School team. Using U-M Department of Emergency Medicine funding, they analyzed data from the Nationwide Inpatient Sample database compiled by the Agency for Healthcare Research and Quality.

The authors calculate that if all emergency patients received the kind of care that the busiest emergency centers give, 24,000 fewer people would die each year.

"It's too early to say that based on these results, patients and first responders should change their decision about which hospital to choose in an emergency," says Keith Kocher, M.D., MPH, the lead author of the new study and a U-M Health System emergency physician. "But the bottom line is that emergency departments and hospitals perform differently, there really are differences in care and they matter."

This is the first time a relationship has been shown on a national, broad-based scale between the volume of emergency patients seen at a hospital and the chance those patients will survive their hospital stay.

Time-critical conditions

Kocher and his colleagues focused on eight high-risk, time-critical conditions. They were: Pneumonia, congestive heart failure, sepsis, the type of heart attack known as an acute myocardial infarction, stroke, respiratory failure, gastrointestinal bleeding and acute respiratory failure.

All require emergency providers to use a certain level of diagnostic skill and technology, and successful treatment depends on the ability of emergency and inpatient teams to deliver specialized treatment. All carry a death risk of at least 3%, and rank among the top 25 reasons emergency patients get admitted to a hospital.

Their results don't give insights into why the differences in survival occur – but for the first time, they show that they do occur, so that further research can probe deeper.

"The take-home message for patients is that you should still call 911 or seek the closest emergency care, because you don't know exactly what you're experiencing," says Kocher, an assistant professor of emergency medicine. "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."

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