Distribution of Emergency Departments According to Annual Visit Volume and Urban–Rural Status: Implications for Access and Staffing

Abstract

Objectives: Ongoing efforts to improve access to emergency care and emergency department (ED) staffing would benefit from a better understanding of the distribution of EDs in the United States by size and location. This article describes the distribution of U.S. ED visit volumes according to ED urban versus rural status. Methods:The authors used the 2007 National Emergency Department Inventories (NEDI)-USA database to identify all nonfederal U.S. hospitals with EDs and their annual ED visit volumes. One of twelve 2003 Urban Influence Codes was applied to each ED location based on its county. These categories were collapsed into urban counties and three types of rural counties: adjacent to urban, large nonadjacent, and small nonadjacent. The number of emergency physicians (EPs) needed to staff the higher-volume rural EDs was estimated.Results: Of the 4,874 U.S. EDs in 2007, 58% were in urban counties and 42% in rural counties. Among the 2,038 rural EDs, 56% were adjacent to urban, 15% were large nonadjacent, and 29% were small nonadjacent. Of the 1,503 lower-volume (< 10,000 visit) EDs, 21% were in urban counties. Of the 3,371 higher-volume ( ‡ 10,000 visit) EDs, 25% were in rural counties. Of the 857 higher-volume rural EDs, 66% were adjacent to urban, 22% were large nonadjacent, and 12% were small nonadjacent. The authors estimate that approximately 5,600 EPs are needed to staff these higher-volume rural EDs.Conclusions: There are many lower-volume EDs in urban areas and higher-volume EDs in rural areas. Most higher-volume rural EDs are in rural areas adjacent to urban counties. These data challenge popular assumptions regarding ED visit volumes, locations, and staffing needs.

Use of Point-of-Care Ultrasound in Connecticut Emergency Departments

“…Although a small state, even Connecticut's smallest EDs have annual patient visit volumes that exceed the national median of approximately 20,000 (21,22). With 96% of EDs reporting access to an US machine and at least occasional use of PoC US, Connecticut EDs compare favorably to other national, regional, and statewide surveys looking at the utilization of US in EDs.…”

Perceptions of graduates from Africa's first emergency medicine training program at the University of Cape Town/Stellenbosch University

“…14,15 Fifth, even though development is expected to occur first in urban areas, new programs should eventually aim for graduates to take leadership roles and practice in rural locations. Most new graduates remained in Cape Town, a finding that is not unexpected given the deficiency of EM providers in rural areas in other countries 16 and given that all but one individual stated an initial preference to practicing in an urban setting. As critical mass develops in urban areas around major academic centres, the government needs to be proactive about decentralizing posts, and training programs should encourage new graduates to consider practicing in and elevating the level of emergency care in rural and semirural areas.…”

Experiences of Pediatric Patients With Sickle Cell Disease in Rural Emergency Departments

“…This is important because 42% of EDs are located in rural environments, [11] and EDs located in rural versus urban environments are generally more likely to be staffed by health care providers (HCPs) who lack board certification and residency training or who have limited access to advanced healthcare technology and specialists. [12,13] In addition, there is limited of research on SCD patients in rural versus urban environments and their care experiences.…”