Abstract
To describe nationwide hospital-based emergency department (ED) closures and mergers, as well as the utilization of emergency departments and inpatient beds, over time and across varying geographic areas in the United States. Observational analysis of the American Hospital Association (AHA) Annual Survey from 2005 to 2015. Primary outcomes were hospital-based ED closure and merger. Secondary outcomes were yearly ED visits per hospital-based ED and yearly hospital admissions per hospital bed. The total number of hospital-based EDs decreased from 4,500 in 2005 to 4,460 in 2015, with 200 closures, 138 mergers, and 160 new hospital-based EDs. While yearly ED visits per hospital-based ED exhibited a 28.6% relative increase (from 25,083 to 32,248), yearly hospital admissions per hospital bed had a 3.3% relative increase (from 45.4 to 43.9) from 2005 to 2015. The number of hospital admissions and hospital beds did not change significantly in urban areas and declined in rural areas. ED visits grew more uniformly across urban and rural areas. The number of hospital-based ED closures is small when accounting for mergers, but occurs as many more patients are presenting to a stable number of EDs in larger health systems, though rural areas may differentially affected. EDs were managing accelerating patient volumes alongside stagnant inpatient bed capacity.
Highlights
Background and importanceU.S acute and hospital-based care capacity have evolved over time, and their relevance is all the more salient given the challenges of the COVID-19 pandemic
The number of hospital-based emergency department (ED) closures is small when accounting for mergers, but occurs as many more patients are presenting to a stable number of EDs in larger health systems, though rural areas may differentially affected
The Emergency Medical Treatment and Labor Act (EMTALA) protects patients’ access to emergency care-in that all who present must receive a medical screening exam, meaningful access to timely hospital and emergency care services is primarily driven by geography, or put the presence of a hospital-based emergency department close by [11]
Summary
U.S acute and hospital-based care capacity have evolved over time, and their relevance is all the more salient given the challenges of the COVID-19 pandemic. This evolution occurs in the context of recent hospital and health system consolidation, with larger facilities capturing greater market share and consolidating care among fewer, more integrated systems nationwide [1]. The Emergency Medical Treatment and Labor Act (EMTALA) protects patients’ access to emergency care-in that all who present must receive a medical screening exam, meaningful access to timely hospital and emergency care services is primarily driven by geography, or put the presence of a hospital-based emergency department close by [11]
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