Small Rural Hospitals with Low-Volume Emergency Departments that May Convert to a Rural Emergency Hospital (REH)

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In the brief, Small Rural Hospitals with Low Volume ED that May Convert to a Rural Emergency Hospital, the NC Rural Health Research Program examines Critical Access Hospitals (CAHs) and Prospective Payment System (PPS) hospitals with no more than 50 beds in rural areas that are eligible to convert to a Rural Emergency Hospital (REH.)  For this study, hospitals with low Emergency Department (ED) volume are considered to be most likely to convert to REH.  We identified 356 REH-eligible hospitals with six or fewer ED visits/day, and 325 with between 6.01-12 ED visits/day.  In comparison to hospitals with greater ED volume (12.01-30 ED visits/day), the hospitals with low-volume ED

  • Are more likely to be in the Midwest, CAHs, government-owned, and not affiliated with a system.
  • Have lower acute inpatient volume (median acute average daily census of 0.9 patients for 0-6 ED visits/day and 2.0 patients for 6.01-12 ED visits/day).
  • Have lower outpatient volume (median annual outpatient visits of 8,381 for 0-6 ED visits/day and 17,249 for 6.01-12 ED visits/day).
  • Are more likely to own and operate their own ambulance service, more likely to have a Rural Health Clinic or a skilled nursing facility, but less likely to be affiliated with an air ambulance company.
  • Have similar access to computed tomography (CT) scanner services but are less likely to provide MRI services.
  • Have fewer overall physicians with hospital privileges, but a similar number of Advanced Practice Providers (APPs).

The REH may be a viable alternative to an inpatient facility, particularly in communities where a rural hospital is at risk of closure.  However, there is little published literature on the characteristics and operations of these facilities from which to generate best practices in implementation. Conversion to REH will require careful attention to many operational issues such as those identified in this study.