Access to Emergency Care in the United States

Received 30 July 2008; received in revised form 23 October 2008 and 11 November 2008; accepted 24 November 2008. published online 09 February 2009.

Refers to article:

Travel or Traffic: Either Way, Emergency Service May Be Delayed , 09 February 2009
Ellen J. Weber
Annals of Emergency Medicine
August 2009 (Vol. 54, Issue 2, Pages 270-271)
Full Text | Full-Text PDF (100 KB)

Study objective

Rapid access to emergency services is essential for emergency care–sensitive conditions such as acute myocardial infarction, stroke, sepsis, and major trauma. We seek to determine US population access to an emergency department (ED).

Methods

The National Emergency Department Inventories–USA was used to identify the location, annual visit volume, and teaching status of all EDs in the United States. EDs were categorized as any ED, by patient volume, and by teaching status. Driving distances, driving speeds, and out-of-hospital times were estimated with validated models and adjusted for population density. Access was determined by summing the population that could reach an ED within the specified intervals.

Results

Overall, 71% of the US population has access to an ED within 30 minutes, and 98% has access within 60 minutes. Access to teaching hospitals was more limited, with 16% having access within 30 minutes and 44% within 60 minutes. Rural states had lower access to all types of EDs.

Conclusion

Although the majority of the US population has access to an ED, there are regional disparities in ED access, especially by rurality. Future efforts should measure the relationship between access to emergency services and outcomes for emergency care–sensitive conditions. The development of a regionalized emergency care delivery system should be explored.

a Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA

b Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA

c Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA

d Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA

e Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA

f VA Medical Center, Philadelphia, PA

g Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Address for correspondence: Brendan G. Carr, MD, MA, 932 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021; 215-573-3976, fax 215-573-2265

Provide feedback on this article at the journal's Web site, www.annemergmed.com.

Supervising editor: Donald M. Yealy, MD

Author contributions: BGC, CCB, JPM, and CAC conceived of and designed the study. BGC, AFS, and CAC obtained the data. BGC drafted the article. All the authors interpreted the data, revised the article, and contributed substantively to the work. BGC takes responsibility for the paper as a whole.

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. The study was supported by the Robert Wood Johnson Foundation and the National Library of Medicine (R21LM008700).

Publication date: Available online February 3, 2009.

Reprints not available from the authors.

PII: S0196-0644(08)02023-4

doi:10.1016/j.annemergmed.2008.11.016

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