When a hospital closes in a community, patients needing
emergency care may spend more time in an ambulance to
receive care in an emergency department (ED). We explored
how a hospital closure affects the time a patient travels
from an incident location where 9-1-1 was called to the
ED in an ambulance.
By combining several data sources, we created a file
summarizing hospitals and hospital characteristics at the
ZIP code level. Our data had 91 closures in the years
2011 to 2014, divided evenly among rural and urban areas.
The closed rural hospitals were smaller, averaging just
39 beds as opposed to 108 beds for all closed hospitals.
Most hospitals, closed and open, were the sole hospital
in the ZIP code. To assemble a file with the total time a
patient is transported in an ambulance from the scene of
an incident to the ED, we used data from the National
Emergency Medical Services Information System (NEMSIS), a
national repository of ambulance call data reporting
total transports (not number of patients). Based on
information about which jurisdictions reported to NEMSIS,
we estimated there were 46 hospital closures that we
could match to NEMSIS. This sample set of hospitals
looked similar to all closed hospitals. We evaluated
differences in transport times in a ZIP code broken out
by the following characteristics: all calls, all calls
without hospital-based ambulance services, calls in rural
ZIP codes, calls in urban ZIP codes, rural calls without
hospital-based ambulance services, and rural calls for
patients 65 years and older.
For those calls defined as rural, the mean transport time
prior to a hospital closure was 14.2 minutes, one minute
slower than the mean time for all calls. The transport
time increased to 25.1 minutes after the hospital closed,
a statistically significant increase of 10.9 minutes or a
76.4% increase. In urban ZIP codes there was no change in
transport times. Patients 65 years and older living in
rural areas had a similar change in transport time as all
rural patients. The times increased from 13.9 minutes to
27.6 minutes, a 13.7-minute increase or a 97.9% change.
Our work measures one aspect of how access to emergency
care through ambulance services changes for patients when
a hospital closes. Our analysis reveals that after a
hospital closes, rural patients spend more time in an
ambulance than prior to the closure. In addition, they
spend more time than urban patients facing closures.
Studies have found that communities, rural and urban,
where hospitals closed tended to have a higher percentage
of elderly and poor residents in addition to higher
unemployment rates and a higher percentage of blacks and
Hispanics. More than half the hospitals in the country
are in rural areas and are the primary source of
emergency medical services in these communities. Over the
years, policymakers at the local, state, and federal
levels have prioritized maintaining local access to
emergency services. The 2017 Medicare Payment Advisory
Commission (MedPAC) report stressed the need to find more
efficient and financially stable ways to deliver
emergency services in rural communities.