When a hospital closes, the ripple effect extends far and wide. Existing patients, the residents of the closing hospital nearby, and the medical facilities caring for those residents are all forced to make unambiguous decisions based on this closure.

Researchers at the University of Alabama at Birmingham (UAB) have studied this ripple effect. They looked at how hospital closings in the United States – 106 in the last decade – affected medical care. They found that some patients who now had to travel further for serious emergency care, such as stroke or heart attack, were likely out of the window for effective treatment.

“Our results showed that the closure of rural hospitals resulted in up to 1% of the population being inaccessible to a hospital within 15 minutes. This period could be important in the case of medical emergencies such as heart attack, stroke or traumatic injury.” said Jan Jansen, MBBS, PhD, Director of the UAB Center for Injury Science and Associate Professor in the Acute Surgery Division of the Department of Surgery. The study was published in the Journal of Surgical Research.

The team found that a third of the closed hospitals were more than 20 miles from the nearest open facility. No new hospitals were built to replace the 106 that were closed. Dr. Jansen wrote that the impact of the closings would likely be disproportionate. The problem is compounded by the status of residents: rural hospitals generally serve the elderly, poor and sick. And of course the reason 106 was closed in the first place was the region’s financial hardship.

The team analyzed the 2010 census data to get their results. Dr. Jansen estimated that 812,314 people couldn’t reach a hospital within 15 minutes. More than 470,000 residents had to drive over 30 minutes for care; 85,500 inhabitants, 45 minutes; and 22,000, an hour.

Most hospitals in Alabama, Arkansas, Kentucky, Oklahoma, Tennessee, and Texas are closed. Others closed in Florida, Maryland, the state of New England, and on the west coast. Texas had the most closed hospitals at 17, followed by Tennessee at 11.

Impact on Active Hospitals

The hospitals that remain to treat the displaced face new problems for both staff and patients. A study published in the Rhode Island Medical Journal looked at the impact of a hospital closure on local emergency rooms.

The Rhode Island Memorial Hospital emergency department closed on January 1, 2018. The researchers assessed this impact on the emergency rooms at Miriam Hospital, Rhode Island Hospital, and Newport Hospital. The closure increased the volume of emergencies at these hospitals, length of stay, and the number of patients who left without checking in.

The pandemic is making it difficult for healthcare workers to handle many medical cases. However, the decline in active rural hospitals may pose a greater threat as the sheer numbers of displaced people could overwhelm the still open hospitals.

Worse still, people may choose not to receive care, especially those unable to make video calls to a doctor. More clinics and hospitals are needed to better manage patient needs and improve access to medical services.

Ralph Chen is an enthusiast for medical topics and advanced technology. When he’s not writing, he spends a lot of time playing popular PC games.

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