Carr Brendan G, Branas Charles C, Metlay Joshua P, Sullivan Ashley F, Camargo Carlos A
Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Ann Emerg Med. 2009 Aug;54(2):261-9. doi: 10.1016/j.annemergmed.2008.11.016. Epub 2009 Feb 7.
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).
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.
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.
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.
对于急性心肌梗死、中风、败血症和重大创伤等急诊护理敏感疾病，快速获得急诊服务至关重要。我们试图确定美国人口获得急诊科（ED）服务的情况。
使用美国国家急诊科库存来确定美国所有急诊科的位置、年就诊量和教学状况。急诊科按类型、患者数量和教学状况进行分类。利用经过验证的模型估计驾车距离、驾车速度和院外时间，并根据人口密度进行调整。通过汇总在指定时间间隔内能够到达急诊科的人口数量来确定可及性。
总体而言，71%的美国人口能够在30分钟内到达急诊科，98%的人口能够在60分钟内到达。教学医院的可及性更有限，16%的人口能够在30分钟内到达，44%的人口能够在60分钟内到达。农村州各类急诊科的可及性较低。
尽管大多数美国人口能够获得急诊科服务，但急诊科可及性存在地区差异，尤其是在农村地区。未来的努力应衡量获得急诊服务与急诊护理敏感疾病结局之间的关系。应探索建立区域化急诊护理提供系统。
