Characteristics of United States Emergency Departments With and Without Hospital-Based Obstetric Services

Emergency department (ED) visits for early pregnancy complications, during pregnancy, and at the time of childbirth are common. Availability of obstetric (OB) services is an important factor in the care of such patients. While hospital-based OB services have declined across the U.S. since 2010, there are no national data on characteristics of EDs with and without on-site OB services. Therefore, we aimed to compare characteristics of U.S. EDs with and without on-site OB services.

We conducted a cross-sectional analysis of all U.S. EDs in short-term acute care hospitals or rural emergency hospitals that responded to the 2023 American Hospital Association Annual Survey. The primary outcome was the presence of on-site OB services, identified following a published algorithm using four AHA variables (provision of OB services, OB level of care, dedicated OB bed, and births per year), supplemented by indication of OB services in the 2023 Centers for Medicare & Medicaid Services Provider of Services file and manual verification. We used descriptive analyses and chi-squared tests to compare characteristics of EDs with and without on-site OB services.

Among 2,968 EDs, 1,932 (65.1%) had hospital-based OB services. Annual overall ED visit volume differed by OB service status (p<0.001). Most hospitals without on-site OB had EDs in the lowest two volume quartiles (Q1 [<8,973 ED visits]: 51.5%; Q2 [8,976-23,906 visits]: 29.3%; Q3 [23,914-49,794 visits]: 14.7%; Q4 [>49,867 visits]: 4.5%). The inverse pattern was observed among EDs with on-site OB services (Q1: 10.8%; Q2: 22.7%; Q3: 30.5%; Q4: 36.0%). A greater proportion of EDs without on-site OB services were in rural locations (no OB: 48.9% rural, 51.1% urban; OB: 32.4% rural, 67.6% urban; p<0.001) and critical access hospitals (no OB: 54.3%; OB: 15.1%; p<0.001). Teaching status differed, as most EDs without on-site OB services were in non-teaching hospitals (no OB: 73.7%; OB: 37.5%, p<0.001).

EDs with and without on-site OB services differ in key characteristics, as EDs without on-site OB services more frequently had lower overall ED visit volumes, were in rural locations, critical access hospitals, and had non-teaching status. Additional work is needed to determine how the presence of OB services influences ED care during pregnancy, and whether availability of in-person or telehealth consultation may mitigate any potential differences.