Rural hospital closures not only have economic and healthcare consequences for local communities, they also impact the operations of nearby hospitals. There are also significant consequences for how nearby hospitals will have to respond to a natural or man-made emergency. Concern over rural hospital closures is not a new phenomenon. Following the introduction of the prospective payment system for Medicare beneficiaries in 1983, many rural hospitals closed due to financial distress - raising fears a thousand hospitals could close before the end of the decade.
Although not the only contributing factor to rural hospital closures at the time, federal-level concern resulted in the establishment of the Critical Access Hospital program to reimburse qualifying rural hospitals according to operating costs rather than the volume of treatment provided.
In order to qualify as Critical Access Hospital, the hospital must provide 24/7 emergency services, maintain no more than twenty-five acute care inpatient beds, the average length of stay must be less than 96 hours, and the hospital must be located at least thirty-five miles from another hospital.
There are now 1,350 Critical Access Hospitals located across the United States accounting for about two-thirds of all rural hospitals; however, the improved payment structure has not prevented a new wave of rural hospital closures. According to the North Carolina Rural Health Research Program, of 162 rural hospital closures between 2005 and 2019, fifty-nine were Critical Access Hospitals.
The Impact on Nearby Hospitals of Rural Hospital Closures
Various studies have been published regarding the economic and healthcare consequences of rural hospital closures. The results of these studies vary according to hospital locations, the reasons for the hospital closures, and the healthcare condition(s) being studied, but generally the impacts are negative.
By comparison, research into the impact on nearby hospitals is limited - the most recent study published by Harvard University in January 2019. The publication's authors found that, rather than increase capacity, nearby hospitals improve operational efficiency to cope with extra patient demand.
Often the improved operational efficiency is achieved by a reduction in excess capacity and shorter patient treatments in order to serve more patients using existing resources. Shorter patient treatments were also found to have negative impacts, with 30-day mortality rates increasing significantly.
What was not discussed in the study was how rural hospital closures would impact nearby hospitals in a natural or man-made emergency. This scenario raises unique concerns because of the increased length of time it may take injured patients to get to a hospital (depending on the nature of the emergency), and because their injuries may have deteriorated into more critical conditions by the time they arrive.
Further Concerns for Hospital Emergency Preparedness
One of the biggest concerns for hospital emergency preparedness is that hospitals who are already serving more patients with existing resources won't have the capacity to cope with a large influx of injured patients - especially those whose conditions deteriorate into more serious injuries. To add to a potential shortages of beds, supplies, and medical personnel following any emergency, patients with exacerbated injuries are more likely to experience medical complications and take longer to recover - occupying beds for longer and consuming more medical supplies.
Hospitals won't be able to transfer these patients to the Critical Access Hospitals that have replaced rural hospitals because of their limited capacities. Nor will they be able to access additional supplies or medical personnel because Critical Access Hospitals have to operate on tight budgets.
There will likely also be a greater “after-event” surge of patients increasing the demand on hospital resources if utility services are affected by the emergency event. If power isn't available to operate home medical appliances, it also means pharmacies won't be able to open, nor community health services that may support the needs of citizens with (for example) mental health issues.
Considerations for Hospital Emergency Preparedness Planning
All healthcare providers in receipt of Medicare or Medicaid payments are required to have an all-hazards emergency preparedness plan (including Critical Access Hospitals). However, where these plans have been put into action, multiple shortcomings have been identified.
The primary issues not only relate to the rate at which patients arrive at hospitals both during and after an emergency, but also the rate at which medical personnel arrive at hospitals to offer their services, and the rates at which both medical and non-medical supplies are consumed.
There have also been issues with non-medical hospital services (i.e. environmental services) and contacting non-medical personnel to resolve these issues. In many jurisdictions, the lack of an online special needs registry has also created problems with prioritizing help where it is most needed.
To help resolve these shortcomings, hospitals are required to factor a communications plan into their hospital emergency preparedness planning. The communications plan is not only for alerting on-site personnel to an emergency, but should be used to liaise with emergency agencies and support business continuity when - and after - an emergency occurs.
Communications Solutions for Emergency Preparedness Planning
Communications solutions for emergency preparedness planning come in many different shapes and sizes to meet individual hospitals' requirements. In the case of hospitals that have been impacted by the closure of nearby rural hospitals, the solutions need to be capable of connecting independently with many different agencies in addition to the hospital's medical and non-medical personnel.
For this reason, ideal communications solutions include features such as unlimited database segmentation, geo-polling, and advanced data management. They can also be integrated with other safety solutions such as mobile panic button apps and special needs registries in order to enhance planning for and responding to an emergency.
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