Dearth of Data on Capabilities May Be Hurting ER Care

THURSDAY March 19, 2009 -- Though most Americans live within an hour of an emergency medical facility, chances are it's not one that can save them when time is of the essence, a new study has found.

The study in the Annals of Emergency Medicine reported that when time is a critical issue in a medical crisis, as is the case with a heart attack or stroke, the nearest facility is not always the best to handle the situation. The dispersal of the U.S. population and a lack of knowledge about the capabilities of individual hospitals make the situation even graver.

"In those life-threatening emergencies, we must blindly rely upon the system to rapidly deliver us to the care that we need," Dr. Brendan Carr, an assistant professor of emergency medicine and epidemiology at the University of Pennsylvania School of Medicine and lead author of the study, said in a news release from the school. "If we knew what services were provided where, we could design a system that would do that for patients everywhere in the country."

People in rural areas seem most at risk of receiving inadequate care in an emergency situation, in part because they generally are not near hospitals that treat great numbers of patients. Studies have shown that hospitals with higher patient volume tend to have better patient outcomes, in part because they have more personnel, specialized equipment and other resources.

For example, Carr's study found that just half of the people living in Maine and Vermont live within an hour of an emergency department that treats at least three patients an hour. In Montana, just 8 percent of the residents have ready access to a higher-volume facility.

The study, conducted with the national Emergency Medicine Network, based at Massachusetts General Hospital, also found that less than half of U.S. residents are within an hour of a teaching hospital. Teaching hospitals tend to offer more sophisticated treatments and have sub-specialists on staff.

Carr, the associate director of Penn's emergency care policy and research division, said it would help if a system were set up so that victims of time-sensitive conditions could skip the closest facility for one that meets the person's specific needs -- similar to the system now in use nationwide for trauma victims. That would first require the capabilities and resources of all U.S. hospitals to be put into a central database, he said.

"We know that hospitals think every day about how to improve the care they give their patients, but those discussions are siloed, largely taking place only in individual hospitals," Carr said. "A truly comprehensive emergency care system, however, needs to be built from a population health perspective, with groups of EMS [emergency medical service] providers and hospitals thinking collaboratively about how to provide the best emergency care to their region."

Improving rural care, he said, might also require such things as increased hospital funding and incentives for doctors to practice at more remote facilities.

More information

The American College of Emergency Physicians has more on issues in emergency medicine.

Posted: March 2009


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