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Health Aff (Millwood). 2014 Aug;33(8):1323-9. doi: 10.1377/hlthaff.2013.1203.

California emergency department closures are associated with increased inpatient mortality at nearby hospitals.

Author information

Charles Liu is a medical student at Harvard Medical School, in Boston, Massachusetts.
Tanja Srebotnjak is a senior fellow at the Ecologic Institute, in San Mateo, California.
Renee Y. Hsia ( is an associate professor in the Department of Emergency Medicine and the Institute of Health Policy Studies, University of California, San Francisco.


Between 1996 and 2009 the annual number of emergency department (ED) visits in the United States increased by 51 percent while the number of EDs nationwide decreased by 6 percent, which placed unprecedented strain on the nation's EDs. To investigate the effects of an ED's closing on surrounding communities, we identified all ED closures in California during the period 1999-2010 and examined their association with inpatient mortality rates at nearby hospitals. We found that one-quarter of hospital admissions in this period occurred near an ED closure and that these admissions had 5 percent higher odds of inpatient mortality than admissions not occurring near a closure. This association persisted whether we considered ED closures as affecting all future nearby admissions or only those occurring in the subsequent two years. These results suggest that ED closures have ripple effects on patient outcomes that should be considered when health systems and policy makers decide how to regulate ED closures.


Organization and Delivery of Care

[Indexed for MEDLINE]
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