Emergency Department Closures and Patient Outcomes: Scoping Review of Impacts on Care, Equity, and System Performance

Emergency department (ED) closures have become increasingly common across health systems worldwide, reflecting mounting pressures from staffing shortages, resource constraints, and rising patient demand. Closures, whether temporary or permanent, pose potential risks to timely access to emergency care and may significantly impact patient outcomes and healthcare system performance. Despite growing attention from policymakers and the public, academic evidence on real-world impacts of ED closures remains fragmented. In this scoping review we compiled and summarized the current literature directly addressing the impacts of ED closures.

Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews criteria, we conducted a search of PubMed.gov, the Cumulative Index to Nursing and Allied Health Literature, and Web of Science databases for papers published in English after the year 2000 that directly addressed ED closures. We screened these papers by title and abstract. This search yielded 15 studies for which we then conducted a forward and backward citation search, ultimately producing 22 unique papers. Data from these papers were initially extracted into a spreadsheet and then organized into thematic tables based on the impacts they discussed.

Our search yielded 1,725 papers, and we ultimately included 22 of these (1.3%). Most studies were observational or quasi-experimental, covering 147 unique ED closures, with some analyzing all United States closures (thousands). We found that we could organize the papers into four themes determined by the impact of ED closures had on the following: 1) patient outcomes (eg, mortality, likelihood of acute myocardial infarction treatment) (n = 14); 2) equity-deserving populations (n = 6); 3) alternate EDs that remain open (n = 10); and 4) on healthcare networks as a whole, including emergency medical services (n = 5). Most of the papers were observational or quasi-experimental in design and drew data from a wide scale of closures, from single-site to national ED closures (> 500 sites). The largest proportion (40%) of studies were based in the U.S.

The literature demonstrated mixed and context-dependent impacts of ED closures. The ED closures consistently adversely affected mortality rates of patients with time-sensitive conditions when travel times or distances exceeded certain thresholds. Closures also disproportionately affected equity-deserving populations. However, the negative impacts were often mitigated in the long term, and were less pronounced in well-resourced systems capable of adaptation. There are key gaps in the literature regarding impacts on conditions that are not time sensitive, on marginalized populations, and on broader system-level performance, which should guide future research.