When a hospital closes for business, the ripple effect extends near and far. Existing patients, the closing hospital's nearby residents, the medical facilities that will tend to these residents -- all are forced to make unique decisions, based on that one closing.

Investigators at the University of Alabama at Birmingham (UAB) have studied this ripple effect. They examined how hospital closures in the U.S. -- 106 in the past decade -- affected medical services. They found that some patients who now had to travel farther for serious emergency care, such as a stroke or heart attack, were likely outside the effective-treatment window.

"Our findings showed that rural hospital closures resulted in up to 1% of the population being no longer able to access a hospital within 15 minutes, a time frame that could be significant in medical emergencies such as heart attack, stroke or traumatic injury," said Jan Jansen, MBBS, PhD, director of UAB's Center for Injury Science and associate professor in the Department of Surgery's division of acute care surgery. The study was published in the Journal of Surgical Research.

The team found that one-third of the closed hospitals were more than 20 miles from the nearest open facility. No new hospitals have been built to replace the 106 that closed. Dr. Jansen wrote that the impact of the closures would likely be disproportionate. Complicating this issue is the status of the residents: Rural hospitals generally serve older, poorer and sicker individuals. And, of course, the reason the 106 closed in the first place was because of the financial straits of the region.

The team analyzed 2010 Census data to come up with their findings. 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 residents, 45 minutes; and 22,000, one hour.

Most of the hospitals closed in Alabama, Arkansas, Kentucky, Oklahoma, Tennessee and Texas. Others closed in Florida, Maryland, the New England states and those along the West Coast. Texas had the most closed hospitals with 17, followed by Tennessee with 11.

Impact on Active Hospitals

The hospitals that remain to treat the displaced patients also face new issues for both staff and patients. A study published in the Rhode Island Medical Journal evaluated the effects of one hospital closure on local emergency departments.

The emergency department of the Memorial Hospital of Rhode Island closed on Jan. 1, 2018. Researchers evaluated this impact on the emergency departments at Miriam Hospital, Rhode Island Hospital and Newport Hospital. The closure swelled the volume of emergency department cases in those hospitals, the duration of stay, and the number of patients leaving without getting checked 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 bigger threat, as the sheer number of displaced patients could overwhelm those hospitals that remain open.

Even worse, people may choose not to get care, particularly those who cannot make video calls with a doctor. More clinics and hospitals are needed to better manage patient needs and to improve access to medical services.

Ralph Chen is an enthusiast of medical topics and advanced technologies. When not writing, he spends time playing popular PC games.