Going the Distance: The Impact of Travel Time on Emergency Surgical Outcomes, Health System Burden

Travel time for emergency services can be a driver of patient outcomes, according to a report published today in JAMA Network Open that linked prolonged travel with higher facility resource use and more severe disease presentation.¹

Travel time was a greater influence of patient outcomes compared with rurality itself | image credit: ysbrandcosijn - stock.adobe.com

“As regionalization continues to impact service delivery and policy efforts to promote access to emergency care are instituted at the federal level, robust metrics for timely access to care and its downstream consequences are needed,” the present authors began. They outline the importance of understanding care access through this lens as various patient barriers, such as travel time for emergency care, remain ill-understood and understudied.

Data were gathered from Florida’s and California’s 2021 Healthcare Cost and Utilization Project State Inpatient and Emergency Department databases, which enabled the researchers to evaluate upwards of 97% of each state’s hospital discharges. Their cohort included patients who sought emergency surgical services for bowel obstructions, appendicitis, diverticulitis, cholecystitis, or a hernia, which prior studies have used to measure care and access delays. Travel times were classified into groups: 15 minutes or less, 16 to 30 minutes, 31 to 60 minutes, 61 to 120 minutes, and beyond 120 minutes. Furthermore, the Rural-Urban Community Area (RUCA) code was used to assess patients’ rurality, with a 3 signifying metropolitan residence, 4 to 6 indicating micropolitan residence, and a code greater than 6 marking rural residence.

The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes were relied upon to grade patients’ disease severity (low or high complexity) at first presentation.

A total of 190,311 patients were included in the analysis, with many aged between 40 and 64 years (41.4%; n = 78,710). Over half of the cohort (52.9%; n = 100,627) were female and more than one-third (31.3%; n = 59,069) were Hispanic. The vast majority of patients (96.2%; n = 183,173) resided less than 60 minutes from the nearest hospital, while the remaining (3.8%; n = 7138) lived more than 60 minutes away.

The data indicated that patients with longer travel time were more likely to present with complex surgical disease. With an increase in travel time there, complex surgical presentations grew more probable. Rurality, the authors noted, was not inherently linked to disease complexity at presentation; however, when travel time was factored in, more rural patients had a greater chance of presenting with complex disease (adjusted OR, 0.83; 95% CI, 0.75-0.92).

More than 60 minutes of travel time was correlated with 19% higher chance of presenting with higher-complexity emergency general surgical disease (95% CI, 12% to 28%), a 32% greater likelihood they would experience an interfacility transfer (95% CI, 15% to 51%), 17% greater likelihood for surgical intervention (10% to 26%), as well as a 41% greater chance of being admitted to the hospital (95% CI, 33% to 50%). Additionally, prolonged travel time was associated with lengthier hospital stays on average (adjusted mean difference, 0.47 days; 95% CI, 0.35-0.59) and greater overall charges (adjusted mean difference, $8284; 95%CI, $5532-$11,035) vs those with travel times below 60 minutes.

While the authors acknowledged their limitations to discern statistical significance, their findings suggest that prolonged travel time is a pertinent barrier to emergency health care, and a factor that complicates patients’ abilities to navigate the health system in a timely manner. This study adds to and supports a body of global literature that centers travel time as a valuable indicator of health care access.^2,3

“These findings were robust to stratification across several key sociodemographic subpopulations. As policy makers work to preserve access to care in rural communities, using metrics that reflect barriers to reaching care and their downstream effect on resources will be key to developing interventions that ensure timely access to care in emergency situation,” the researchers concluded.¹

References

1. Clark NM, Hernandez AH, Bertalan MS, et al. Travel time as an indicator of poor access to care in surgical emergencies. JAMA Netw Open. 2025;8(1):e2455258. doi:10.1001/jamanetworkopen.2024.55258

2. Stewart BT, Tansley G, Gyedu A, et al. Mapping population-level spatial access to essential surgical care in Ghana using availability of bellwether procedures. JAMA Surg. 2016;151(8):e161239. doi:10.1001/jamasurg.2016.1239

3. Alkire BC, Raykar NP, Shrime MG, etal. Global access to surgical care: a modelling study. Lancet Glob Health. 2015;3(6):e316-e323. doi:10.1016/S2214-109X(15)70115-4