Distribution of Emergency Departments According to Annual Visit Volume and Urban-Rural Status: Implications for Access and Staffing
Distribution of Emergency Departments According to Annual Visit Volume and Urban-Rural Status: Implications for Access and Staffing
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DOI：
10.1111/j.1553-2712.2010.00924.x
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发表时间：
2010-12-01
影响因子：
4.4
通讯作者：
Camargo, Carlos A., Jr.
中科院分区：
文献类型：
--
作者：
Muelleman, Robert L.;Sullivan, Ashley F.;Camargo, Carlos A., Jr.
目标：更好地了解美国急诊室的规模和地点分布，将有助于改善获得急诊护理和急诊室 (ED) 人员配置的持续努力。本文根据 ED 城市与农村状况描述了美国 ED 就诊量的分布。 方法：作者使用 2007 年国家急诊科库存 (NEDI)-USA 数据库来确定所有拥有 ED 的非联邦美国医院及其年度 ED 就诊量。 2003 年十二个城市影响代码之一适用于每个 ED 地点（基于其所在县）。这些类别被分解为城市县和三类农村县：与城市相邻、不相邻的大县和不相邻的小县。对数量较多的农村急诊室所需的急诊医生 (EP) 人数进行了估计。结果：2007 年美国 4,874 名急诊室中，58% 在城市县，42% 在农村县。在2038个农村行政区中，56%与城市相邻，15%为大型不相邻，29%为小型不相邻。在 1,503 个访问量较低（< 10,000 人次）的急诊室中，21% 位于城市县。在 3,371 个访问量较大（>= 10,000 次就诊）的急诊室中，25% 位于农村县。在 857 个人口较多的农村 ED 中，66% 毗邻城市，22% 为大型不毗邻，12% 为小型不毗邻。作者估计，大约需要 5,600 名 EP 来为这些数量较多的农村急诊室配备人员。结论：城市地区有许多数量较少的急诊室，而农村地区则有许多数量较多的急诊室。大多数数量较多的农村急诊室位于与城市县相邻的农村地区。这些数据挑战了有关急诊就诊量、地点和人员需求的普遍假设。学术紧急医学 2010； 17:1390-1397 (C) 2010 年，学术急诊医学学会。
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.ACADEMIC EMERGENCY MEDICINE 2010; 17:1390-1397 (C) 2010 by the Society for Academic Emergency Medicine.