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 mid-level 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.
The evaluation of the critical access hospitals cardiac subsystem of care includes:
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
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.