Obstetric care in rural critical access hospitals: A domestic application of the World Health Organization Emergency Obstetric Care framework in rural communities

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2025-05-24 DOI:10.1111/jrh.70037

Annie L. Glover PhD, MPH, MPA, Diane Brown MPH, Carly Holman MS, Megan Nelson MSW

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引用次数: 0

Abstract

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.

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农村关键医院的产科护理：世界卫生组织紧急产科护理框架在农村社区的国内应用

在过去的30年里，美国与妊娠相关的死亡率稳步上升；在同一时期，由于农村医院和产科关闭，农村社区失去了获得护理的机会。农村危重医院（CAHs）往往是农村社区孕妇需要紧急护理的唯一选择。这项研究的目的是对没有产科部门的医院满足其所服务的农村社区紧急产科护理需求的能力进行统一评估，目的是促进可用于农村情况的持续产科应急准备评估。研究小组对蒙大拿州的全州医院护理系统进行了设施评估。在有产科的医院（N = 25）使用疾病控制和预防中心（CDC）护理水平评估工具（LOCATe）。该小组采用了世界卫生组织（WHO）紧急产科护理（EmOC）框架，以评估没有产科部门（N = 34）但根据《紧急医疗和劳动法》（EMTALA）对产科急诊患者的义务的医院的准备情况。调查结果：没有产科科室的受访医院中，没有一家达到提供全面产科急诊（CEmOC）的准备标准，只有一家达到提供基本产科急诊（BEmOC）的准备标准。结论：必须开展大量工作，使CAHs达到能够安全有效地筛查、稳定和转移或接受产科急诊的准备水平。世卫组织紧急产科服务框架可为评估没有产科的医院的能力提供一个起点，但应制定标准化评估，如LOCATe，以改善产科急诊的准备情况。

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来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.