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A pilot study describing access to emergency care in two states using a model emergency care categorization system
Sage R Myers1, Rama A Salhi, E Brooke Lerner
1Division of Pediatric Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
Summary
A new system categorizes hospital emergency departments (EDs) by capability. While most people can reach advanced care within an hour, this study highlights gaps in emergency care access and planning.
Area of Science:
- Emergency Medicine
- Health Services Research
- Public Health Policy
Background:
- The Institute of Medicine identified a need for categorizing emergency care capabilities.
- A uniform system is lacking, hindering benchmarking, regionalization, and informed patient decisions.
- This study pilots an emergency department categorization system.
Purpose of the Study:
- To pilot the deployment of a novel emergency department (ED) categorization system.
- To assess the distribution of emergency care capabilities across hospitals.
- To evaluate population access to different levels of emergency care.
Main Methods:
- A five-tiered ED categorization system was designed.
- Surveys of emergency departments in Pennsylvania and Wisconsin assessed staffing, resources, and practices.
- Prehospital transport times determined population access to categorized EDs.
Main Results:
- 247 of 297 (83%) EDs surveyed.
- 25% of hospitals provided advanced care, 10.5% comprehensive, and 1.6% pediatric critical care.
- 75.1% of the general population could reach advanced/comprehensive EDs within 60 minutes; 56.2% of children could reach pediatric critical/comprehensive EDs.
Conclusions:
- Fewer than half of EDs offer advanced or comprehensive emergency care.
- While most have access, 25% of the population lacks timely access to higher-level care.
- The ED categorization scheme has implications for planning, patient choice, and regional systems.
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