农村急救医院的产科护理：世界卫生组织紧急产科护理框架在农村社区的国内应用。
Obstetric care in rural critical access hospitals: A domestic application of the World Health Organization Emergency Obstetric Care framework in rural communities.
作者信息
Glover Annie L, Brown Diane, Holman Carly, Nelson Megan
机构信息
Rural Institute for Inclusive Communities, University of Montana, Missoula, Montana, USA.
School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
出版信息
J Rural Health. 2025 Mar;41(2):e70037. doi: 10.1111/jrh.70037.
PURPOSE
Pregnancy-related mortality has increased steadily over the last 30 years in the United States; during the same period, rural communities have lost access to care as rural hospitals and obstetric units have shut their doors. Rural critical access hospitals (CAHs) are often the only option for a pregnant person in a rural community needing emergency care. This study aimed to apply a uniform assessment of the capacity of hospitals that do not have obstetric units to meet the emergency obstetric care needs of the rural communities they serve, with the goal of facilitating ongoing obstetric emergency readiness assessments that can be used in the rural context.
METHODS
The study team conducted facility assessments across Montana's statewide system of hospital care. The Centers for Disease Control and Prevention (CDC) Levels of Care Assessment Tool (LOCATe) was used in hospitals with an obstetrics unit (N = 25). The team adapted the World Health Organization (WHO) Emergency Obstetric Care (EmOC) framework to assess readiness in hospitals without an obstetrics unit (N = 34) but with Emergency Medical Treatment and Labor Act (EMTALA)-based obligations to patients presenting to emergency departments with obstetric emergencies.
FINDINGS
None of the responding hospitals without obstetric units met criteria indicating readiness to provide comprehensive emergency obstetric care (CEmOC), and only one hospital met criteria indicating readiness to provide basic emergency obstetric care (BEmOC).
CONCLUSION
Significant work must be done to bring CAHs up to a level of readiness where they can safely and effectively screen, stabilize, and transfer or accept an obstetric emergency. The WHO EmOC framework can provide a starting point for assessing the capacity of hospitals without obstetric units, but a standardized assessment, such as LOCATe, should be developed to improve readiness for obstetric emergencies.
目的
在过去30年里，美国与妊娠相关的死亡率一直在稳步上升；在此期间，随着农村医院和产科病房纷纷关闭，农村社区获得医疗服务的途径减少。农村急救医院（CAH）往往是农村社区孕妇需要紧急护理时的唯一选择。本研究旨在对没有产科病房的医院满足其所服务农村社区紧急产科护理需求的能力进行统一评估，目标是促进可在农村地区使用的持续产科应急准备评估。
方法
研究团队对蒙大拿州全州范围的医院护理系统进行了设施评估。在设有产科病房的医院（N = 25）中使用了疾病控制和预防中心（CDC）的护理水平评估工具（LOCATe）。该团队采用世界卫生组织（WHO）的紧急产科护理（EmOC）框架，对没有产科病房（N = 34）但根据《紧急医疗救治和分娩法案》（EMTALA）对产科急诊患者负有义务的医院进行应急准备评估。
结果
在回复的没有产科病房的医院中，没有一家达到表明具备提供全面紧急产科护理（CEmOC）准备程度的标准，只有一家医院达到表明具备提供基本紧急产科护理（BEmOC）准备程度的标准。
结论
必须开展大量工作，使农村急救医院达到能够安全有效地筛查、稳定病情并转诊或接收产科急诊的应急准备水平。WHO的EmOC框架可为评估没有产科病房的医院的能力提供一个起点，但应开发一种标准化评估方法，如LOCATe，以提高产科急诊的应急准备能力。
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