Critical Access Hospitals

Through their emergency departments, critical access hospitals can provide vital emergency care to patients in cardiac arrest. The primary eligibility requirements for critical access hospitals include:

  • 25 or fewer acute care impatient beds.
  • Location more than 35 miles from another hospital.
  • Maintenance of an annual average length stay of 96 hours or less for acute care patients.
  • Provision of 24/7 emergency care services.

Critical access hospitals in rural areas have issues with recruitment & retention of providers, are often staffed by one medical doctor, and make use of locum providers, "travelers," and midlevel providers. These hospitals see a low volume of high acuity patients, and providers often have less experience responding to high acuity emergencies such as an out-of-hospital cardiac arrest. To fill gaps in staff and experience, many critical access hospitals make use of telemedical services, which connect their emergency department by dedicated line to a team of emergency medical providers in an urban setting.

Evaluation

The evaluation of the critical access hospitals cardiac subsystem of care includes:

  1. Mapping of the critical access hospitals’ response processes to out-of-hospital cardiac arrest calls. The resulting process flow maps in conjunction with time stamp data may assist the critical access hospital’s continuous quality improvement efforts. System wide mapping allows the medical director to follow patient care from start to finish on any case.
  2. System-wide exercises to test and improve critical access hospitals’ documentation procedures and communication with other subsystems.

Barriers to Efficiency

  • Critical access hospitals' staffing is reduced at nights. Physicians are not required to be on site, but has to meet criteria for response that varies by hospital and state.
  • Critical access hospitals often provide limited services in cardiac care and thus maintain agreements with tertiary care facilities regarding transfer of cardiac arrest patients.
  • Critical access hospitals face challenges in the adoption of electronic health records due to limited resources and connectivity issues such as broadband availability.

Resources

General

System Approach

  • Hospital Response, Every Second Counts. Every Action Matters. A community response planning guide for sudden cardiac arrest, The Medtronic Foundation Heart Rescue Project
  • RACE CARS – Regional Approach to Cardiovascular Emergencies (RACE) Cardiac Arrest Resuscitation System (CARS), North Carolina

Cardiac Arrest Protocols and Resources

Electronic Health Records

EKG Data Transfer

Health Information Exchange

Telemedicine