Study: Emergency Rooms Closing as Patient Demand Rises
Nearly 30 percent of hospital emergency rooms closed over the last two decades—an alarming trend as ER visits continue to jump, new research shows. In 1990, there were 2,446 hospitals with emergency rooms in non-rural areas; that number dropped to 1,779 in 2009, according to findings published Tuesday in the Journal of the American Medical Association. Meanwhile, total emergency room visits rose by more than 35 percent. The emergency rooms that closed typically had low profit margins; served patients below the poverty level with poorer forms of insurance, like Medicaid; and were located in competitive markets. The trend is problematic because it means remaining ERs are overcrowded, require patients to wait longer for care, and can't provide optimal care, the researchers said. "This is a continuously deteriorating situation," study author Renee Hsia, an emergency physician at the University of California--San Francisco, told Reuters. "It's a threat to everyone's care."
When a Hospital Is Bad for You
The U.S. News Best Hospitals rankings and other resources can help steer you to a top-notch hospital when a procedure or condition requires exceptional skill. For routine care, such as repairing a torn rotator cuff or inserting a heart stent, most hospitals will do a fine job. Still, "most" is not "all." Sometimes a particular hospital can be the right choice for some patients but the wrong one for you.
There aren't many hospitals so terrible that they're lethal. A 50 percent death rate or other glaring red flag would prompt padlocks on the doors. But you don't want a place that has little experience with your surgical or medical needs—or is less alert than it should be for anything that could go wrong. Rates of postsurgical complications such as bleeding, infection, and sudden kidney failure vary surprisingly little, according to a study last year of nearly 200 hospitals across the country.
What does differ are deaths from such complications, says John Birkmeyer, a professor of surgery at the University of Michigan Medical School and the study's coauthor. Mortality rates at some hospitals in the study were almost twice as high as at others. A good hospital, says Birkmeyer, catches problems and responds quickly. [Read more: When a Hospital Is Bad for You.]
What Hospital Certifications Say—and Don't Say
Someone diagnosed with a deadly brain tumor is likely to seek out one of the U.S. News Best Hospitals. But let's be honest. If you suffer from diabetes or even breast cancer—and certainly if you're in an ambulance battling a heart attack or stroke—you're going to head for a hospital in town.
How to choose among the ones near you? Research shows that most people ask friends and relatives, especially those in the medical profession, says Eric Schneider, associate professor of medicine at Harvard Medical School and a senior scientist at the Rand Corp. But growing consumer demand for measures that are more objective has professional groups scrambling to provide official certifications for hospital programs that meet standards for treating specific diseases. The American Heart Association, for example, recognizes institutions that treat heart attacks or strokes according to specific evidence-backed guidelines, while a consortium led by the American College of Surgeons flags breast cancer centers that go the extra mile. To qualify, hospitals typically report in categories from physician credentials to patient testing to medication timing—in other words, how closely they adhere to practice guidelines established by the top medical groups in the field. Next comes a visit by the certifying group's outside experts.
Certifications can be valuable tools for consumers because they encourage participating hospitals to find (and presumably fix) systemic problems, Schneider says. Moreover, those taking the trouble to get these stamps of approval (aside from considerable time, applying can run from several thousand dollars to as much as $50,000) likely specialize in treating the specific disease. And the fact that outside experts peer over the hospital wall means patients can assume at least minimal standards of care. [Read more: What Hospital Certifications Say—and Don't Say.]