Trauma and emergency surgical care at rural emergency hospital–eligible facilities: Interstate variation and policy implications for rural health systems

INTRODUCTION: Timely access to emergency surgical care is a key metric for health system development and performance. To mitigate the risks of rural hospital closures in the United States, the 2021 Consolidated Appropriations Act introduced the rural emergency hospital (REH) designation, which promotes closure of inpatient units in small hospitals in favor of emergency and outpatient services via supplemental funding and reimbursement. We investigated trauma and emergency general surgery volumes at REH-eligible hospitals to evaluate the potential impact of REH designation on trauma and emergency general surgery care. METHODS: We used the 2021 Healthcare Cost and Utilization Project from five geographically diverse states (California, Florida, Iowa, Maryland, and Wisconsin) to select encounters where adult patients were treated for acute injuries or emergency general surgery conditions. We then identified REH-eligible hospitals (critical access hospitals or rural hospitals with