Distribution of emergency departments according to annual visit volume and urban-rural status: implications for access and staffing.
OBJECTIVE
ongoing efforts to improve access to emergency care and emergency department (ED) staffing would benefit from a better understanding of the distribution of EDs in the United States by size and location. This article describes the distribution of U.S. ED visit volumes according to ED urban versus rural status.


METHODS
the authors used the 2007 National Emergency Department Inventories (NEDI)-USA database to identify all nonfederal U.S. hospitals with EDs and their annual ED visit volumes. One of twelve 2003 Urban Influence Codes was applied to each ED location based on its county. These categories were collapsed into urban counties and three types of rural counties: adjacent to urban, large nonadjacent, and small nonadjacent. The number of emergency physicians (EPs) needed to staff the higher-volume rural EDs was estimated.


RESULTS
of the 4,874 U.S. EDs in 2007, 58% were in urban counties and 42% in rural counties. Among the 2,038 rural EDs, 56% were adjacent to urban, 15% were large nonadjacent, and 29% were small nonadjacent. Of the 1,503 lower-volume (< 10,000 visit) EDs, 21% were in urban counties. Of the 3,371 higher-volume (≥ 10,000 visit) EDs, 25% were in rural counties. Of the 857 higher-volume rural EDs, 66% were adjacent to urban, 22% were large nonadjacent, and 12% were small nonadjacent. The authors estimate that approximately 5,600 EPs are needed to staff these higher-volume rural EDs.


CONCLUSIONS
there are many lower-volume EDs in urban areas and higher-volume EDs in rural areas. Most higher-volume rural EDs are in rural areas adjacent to urban counties. These data challenge popular assumptions regarding ED visit volumes, locations, and staffing needs.
Departments of Emergency Medicine at University of Nebraska Medical Center, Omaha, NE, USA. rmuellem@unmc.edu
Robert L
RL
Muelleman
Ashley F
AF
Sullivan
Janice A
JA
Espinola
Adit A
AA
Ginde
Michael C
MC
Wadman
Carlos A
CA
Camargo
D016208:Databases, Factual; D003710:Demography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D020380:Needs Assessment; D010561:Personnel Staffing and Scheduling; D040841:Resource Allocation; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population; D014481:United States; D019037:Urban Health Services / Q000706:statistics & numerical data*; D014505:Urban Population; D000078329:Workforce