#37 Rural Emergency Medicine

Emergency departments in rural areas work in austere conditions that often require critically ill patients to transfer to larger hospitals that can provide a higher level of care. Kent Herbert, emergency physician, discusses what resources are available at rural hospitals and the process for transferring patients to higher levels of care.

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What is a critical access hospital?

Critical Access Hospital (CAH) is a designation given to eligible rural hospitals by the Centers for Medicare & Medicaid Services in response to over 400 rural hospital closures during the 1980s and early 1990s.

The CAH designation is designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities.

Eligible hospitals must meet the certain conditions, such as the following:

  • Have 25 or fewer acute care inpatient beds
  • Be located more than 35 miles from another hospital (exceptions may apply)
  • Provide 24/7 emergency care services
  • Have swing beds. A swing bed is a bed that can be used for either acute care or post-acute care/skilled nursing facility (SNF) care, which gives the facility flexibility to meet unpredictable demands for acute care and SNF care.

The above information was gathered from Rural Health Information Hub: Critical Access Hospitals

Episode Highlights

  • When discharging patients who live in rural areas and may present to a small hospital for emergency care, it’s important to counsel them to bring as much of their medical information as possible such as their previous discharge summary, list of medications, and very specific wound care instructions.
  • Sending hospitals may not have the resources to definitively diagnose a patient (e.g. a CT scan) before transferring them to a receiving hospital. Dr. Herbert stressed the importance of the staff from receiving hospitals to be have realistic expectations of what rural hospitals can provide.
  • Hospitals have no obligation to accepts patients from another hospital.