Based on The University of North Carolina Cecil G. Sheps Center for Health Services Research 170 rural hospitals across 33 states have been closed since 2005. This is a trend that is accelerating, since at minimum, 10 hospitals have closed every year since 2013. The financial risk and pressures are higher with the onset of the COVID-19 pandemic.
Telehealth can provide the possibility of rural health care
Rural hospitals are faced with a myriad of issues, such as the competition for highly sought-after professionals graduates of medical schools and keeping economies of scale investing in capital and advanced technologies, and decline in population within the regions which they provide. The process of recruiting is especially difficult when rural hospitals compete with the facilities that cities have to offer.
One of the strategies that have been proven successful by MidMichigan Health, Midland, Mich. It is to create the family medicine residency which offers a more flexible and flexible curriculum than the traditional internal medicine path and entices many of the graduates from the residency program to remain within their health care system. Due to the relatively low number of patients who attend the specialists are often hired to serve in different locations and alternate their work in various clinics and hospitals.
Rural hospitals are crucial assets that act as the main safety net for more than one in six Americans that is, over 52 million. According the Kaiser Health Network, nearly 11 million reside in county without a hospital and another 18 million live in a county with an institution but have there are no ICU (ICU) bed.
This article focuses on rural hospitals which are not critical access hospitals.
The importance of rural facilities
Although some of the advantages of rural hospitals could appear obvious, it’s important to explain the reason why they are essential to sustain and grow. The most important thing for the rural health system, according to MidMichigan Health, is the capability to provide “appropriate care close to home.”
A variety of emergency conditions such as strokes, heart attacks and the complications of the birth process are time-sensitive and even a few minutes can drastically alter the odds of survival. Rural communities can be several hours away from a hospital equipped with the best medical treatment and failure to access timely treatment can lead to a number of avoidable deaths.
Beyond emergencies, the lack of access to routine medical care for chronic ailments lowers the chances that patients will adhere to their care schedules. As per the Centers for Disease Control and Prevention (CDC) patients who live in rural areas have a higher chance of dying from all the leading causes of death, which includes chronic causes like cancer, heart disease chronic respiratory diseases and stroke.
Rural facilities are being built
Capital projects that are large are often a daunting task for smaller companies, however there are a few key elements that can increase the effectiveness and efficiency of construction in the context of a rural hospital.
Strategies that may help rural hospitals are the following:
Advancing profitable service lines. A key element is to begin with profitable services that can increase the revenue of the hospital and help fund future upgrades. Although surgery, imaging and treatment for cancer are costly building projects modern facilities and technologies will help attract surgeons and physicians to increase numbers. They could also attract patients to the hospital that would otherwise have to travel further to another hospital to receive elective treatment.
The spaces for surgery, such as endoscopy are vital for a rural population that is aging. Rooms for procedures can be shared with surgical suites in order to make use of resources and permit the flexibility of staffing. Instrument processing and sterile equipment are able to be placed in both surgical and procedural rooms. In certain instances, based on caseloads and schedules operating rooms can offer more capacity than the surgical rooms.
The spaces for surgical and procedural procedures should be designed with the greatest flexibility to be utilized for a variety of procedures with minimal modifications to equipment and materials. The investment in building technologies and systems such as surgical booms, modern lighting better HVAC, and more emergency power systems, will enhance the process of care, that allows patients to return sooner and lowers the risk of infection or rehospitalization.
Additionally, the areas for post-operative and pre-operative care must be designed to move around the day, creating the use of a smaller space to accommodate the same number of patients. A small space, along with adequate visibility of patients will allow for a more efficient process for staff.
The importance of investing in flexible clinics. Space for clinics that are flexible and adaptable to a vast variety of applications is essential for rural health healthcare. Rural communities don’t require full-time specialists in cardiology or orthopedics however, they need access to these services.
The right-sized and properly equipped exam rooms are able to meet the needs of families in medical and primary care needs in addition to rotating special services and telehealth demands. Exam rooms must be equipped to meet the basic requirements for every room, and include special equipment and supply carts close by that could be brought to each specialist at different times. The technology for telehealth in the room such as computers and digital cameras, allows local healthcare providers and patients to directly connect to specialists from anywhere in the world.
Pay attention to the spaces that support the clinic, in addition. Consult rooms are essential for patient education and could double as telehealth areas. Educational spaces or group consulting can be used to facilitate classes that help patients manage chronic health issues.
Additionally flexible work spaces for staff let rotating specialists as well as their staff members who accompany their colleagues to have a home base for each rotation. The model of two-sided exam rooms can be especially effective for this, since it offers off-stage collaboration spaces for healthcare professionals to coordinate their the treatment regimens, without being heard by the patients.
Behavioral health is a possibility to be integrated into your rural health center well. Integrating these services into a the clinic’s flexible space gives access for primary care professionals to refer patients through an individual handoff to specialists in behavioral health. Initial introductions are possible in the exam room during a doctor appointment when the physician decides that the patient must be referred to a specialist.
Combining the services can lower the stigma that can make certain patients shy away from seeking the services of a behavioral health professional.
Offering regular care at home. Another area for investing is the repeat of treatments and services for chronic illnesses, in which patients might not want to travel so far. The ability to provide these services close to the home of the patient is essential to ensure the long-term health of patients. It is good to know that these services aren’t as costly to construct as they are.
Rehab requires regular visits and lengthy trips to central facilities can reduce the chance of a patient’s adhering to. Rehab prior to surgery is also associated with greater outcomes and a shorter time to recover, particularly in the case of joint injuries. One Mayo Clinic study showed that through undergoing rehab prior to surgery, patients were able to return to their sports 20% more quickly than those who didn’t undergo the program.
Rehabilitation spaces are fairly simple to integrate in rural facilities The dimensions of the program can be altered depending on the amount of patients that will be served and the facilities are easy to set up. Rehabilitation spaces may be open at night to hospital staff or community members for general fitness to boost utilization and establish healthy practices.
Design considerations that are essential include the need to create large, space that is flexible and flexibility, plenty of natural light and views of the outdoors, as well as adequate staff visibility in the gym’s space. Separation of general fitness space and the clinical area must be thought of if the space is accessible to the public.
Other chronic diseases may require specialized areas which are essential to maintain the health of patients. Infusion and dialysis therapies require frequent visits from patients that need a significant amount of time for patients to travel to and from central services. Over 20% of patients who require dialysis reside within rural regions, which is why the availability of care facilities close to the patients is crucial.
In addition, many patients with other chronic ailments such as heart failure need frequent infusions, or regular visits to specialist clinics in order to treat their conditions. In a recent study the treatment of atrial fibrillation (AF) patients by utilizing the specially-designed AF clinic dramatically decreased the number of stroke and hospitalizations.
creating flexible solutions and multi-use areas. One of the most important factors in the success of rural health construction is maximising the use of the space by making it adaptable. As mentioned previously the layout of clinics can be adapted to a variety of specificities. Additionally, other spaces like observation rooms are able to accommodate a variety of requirements.
The observation rooms can be utilized as an Emergency department (ED) as well as for prep and recovery, and even longer post-surgical stays that do not need an overnight bed. If they’re located close to both surgery and ED and surgery, they can be able to flex to switch between the two services. In this scenario they will require utilities to support both needs, such as the power, medical gases and HVAC systems. Additionally, they require a clear view from a nursing station. If the rooms are used for extended stays, consideration should be given to the accessibility of toilets for patients and privacy and lighting to allow for sleeping and recuperation.
Inpatient rooms must be adaptable and able to accommodate a variety of acute conditions. Rural hospitals typically provide basic medical-surgical services, however some might require intermediate care as well as ICU levels of treatment. They might be required only occasionally for instance, when there is an outbreak of COVID-19 the community, however it is essential to build the infrastructure to the facility in advance to meet the needs in the event of a need.
Room dimensions, equipment placement medical gas, HVAC and emergency power must be made available to ensure that all or some rooms for patients can be able to flex their acuity during an emergency. Rural hospitals might not have enough staff to accommodate patients with greater acuity which is why additional services can be offered remotely through Telehealth. Offering support for technology both in the hospital and at the nurse station to allow remote monitoring of patients is essential to provide this additional assistance. Through allowing for flexibility in the level of care and care, patients can be taken at a lower cost with greater involvement from family members.
Certain hospitals may also consider the sharing of resources between other institutions can help them give the best care near to the home. Simple examples of this are specific imaging like magnetic resonance imaging nuclear medicine, nuclear medicine and the positron emission tomography-computed imaging, each of which is offered via mobile trailers. A dock at the exterior of the facility permits three or four hospitals to share an imaging device that is scheduled to visit each hospital on a weekly basis to meet the demands of patient volume.
Other areas that are intensive like the sterile processing area, can be combined into one off-site facility, which can be used to service multiple hospitals. But care must be taken to take into account the cost and logistics involved with transporting instruments between and back to the facility, and also the possibility of having surplus equipment and supplies because of long turnaround times.
Replacing, rather than investing in. Hospitals are typically maintained for a long time and ongoing projects upgrade or expand one part at each time. Renovating a hospital in its entirety can seem like a daunting task for any company, however typically, it’s the most efficient and cost-effective option.
A lot of older facilities lack the infrastructure required to allow for improvements, such as the capacity of the central facility and the floor-to-floor width that is required by modern HVAC systems that are code-compliant. In addition, the renovations already on their own could be more expensive because of the phasing process and operational issues of maintaining care for patients during construction.
A new facility may also offer the chance to redefine the way of providing healthcare. A current structure and the requirement to build in phases will naturally limit design possibilities, while new facilities allow clinicians to consider everything from the arrangement of departments up to specifics like nurse-patient ratios, preparation of medication and the processing of surgical instruments.
Based on the date that the hospital was built as well as shifts in population patterns, some hospitals could require much smaller footprints for a new facility than the ones they are currently in. In addition the possibility of having land in a rural area could allow for a lower cost of building a new hospital than a similar facility located in a more densely-populated region.
A vital component
Rural hospitals provide regular and essential healthcare in the local community to hundreds of millions of Americans in almost every state. They constitute a crucial part of the health system.
Strategies such as those mentioned here are efficient strategies to rebuild rural health facilities.