April 10, 2009

Many Americans Lack Quick Access to Top-Quality Emergency Care

Since time is often critical in an emergency, it is important to know whether the ER you are going to is capable of handling...
New research shows that many Americans — particularly those living in rural areas — may lack access to speedy and high-quality medical care in emergency situations. The study comes out of the University of Pennsylvania and was published in the Annals of Emergency Medicine.

... [H]igher-volume hospitals usually have better patient outcomes because they are better staffed and may provide more sophisticated treatment and equipment.

"Whether you are bleeding to death from an injury, having a heart attack, or having a stroke, the common denominator is time. In those life-threatening emergencies, we must blindly rely upon the system to rapidly deliver us to the care that we need," says lead author Brendan Carr. He and his team wanted to quantify the time it would take various individuals around the country to arrive at an emergency room, as well as the quality of care one could expect to receive. It's been noted in past studies that higher-volume hospitals usually have better patient outcomes because they are better staffed and may provide more sophisticated treatment and equipment.

The team looked at data from ERs all over the country, which included information about the volume of patients seen at each hospital, the teaching status of each hospital, and, of course, their locations. The researchers used a model to determine distances, driving speeds, and release times pertaining to each ER.

They found that while 98% of the population is within an hour's drive of a hospital, only 71% are within half an hour -- still a long journey when time is of the essence. Being in close proximity to teaching hospitals, which often have specialists present day and night as well as more advanced treatment methods, was less common: only 44% of the population had access within one hour, and 16% within half an hour. When one looks at the states individually, the picture is even more striking: in South Dakota, just 13% of the residents live less than an hour away from an ER that receives more than three patients per hour. In Montana, this number drops to only 8%.

Carr points out that the lack of a good classification system of the country's emergency care has been a real shortcoming to fixing the system in the past: "If we knew what services were provided where, we could design a system that would do that for patients everywhere in the country." He says that in order to make change to the current system, the problem should be viewed from a "population health perspective," with EMS workers and hospitals working together to provide the best care — in effect creating a "regionalized emergency care delivery system." He adds that incentives might be needed to increase the level of care in the most rural areas.
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