Comparing Patient Safety in Rural Hospitals by Bed Count

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Cutler, Population Health and Health Policy


Objectives: Patient safety is an important national issue. To date, there has been little attention paid to patient safety in rural hospitals, which make up nearly half of all U.S. hospitals. Information is needed to target interventions for improving patient safety. Our objective was to determine how patient safety rates, offered services, and patient mix vary by bed count among rural hospitals.

Methods: Using the 2000 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), we calculated mean observed and risk-adjusted rates for 19 rural hospital patient safety indicators (PSIs), according to bed count. Rates were risk-adjusted for patient sex, age-gender interactions, comorbidities, and diagnosis-related group (DRG) clusters. We classified HCUP hospitals by actual bed counts—obtained from the AHA Annual Hospital Survey—rather than using the preclassified hospital bed size variable in the HCUP dataset (which differs by region). We examined by bed count the offered services and patient types treated by rural hospitals. T-tests and chi-square tests were used to determine statistically significant differences in continuous and categorical variables, respectively. Of the 446 rural hospitals in the NIS database, 144 facilities—primarily in the South—lacked AHA identifiers and therefore actual bed numbers could not be obtained. We studied the remaining 302 rural hospitals. Hospitals were classified into three size categories: small (fewer than 50 beds), medium (50–99 beds), and large (100 or more beds).

Results: Small rural hospitals had rates of potential patient safety events that were significantly lower than those of large rural hospitals for three of the 19 PSIs (iatrogenic pneumothorax, infection due to medical care, and postoperative hemorrhage/hematoma). The types of services offered by rural hospitals varied significantly according to bed numbers, and the likelihood of an offered service increased as bed counts increased. The types of patients treated by rural hospitals, however, did not vary significantly by bed count. The results suggested that rural hospitals differ substantially by offered services and differ somewhat in PSI rates, relative to bed counts. But given the limited information on patient severity using administrative data, future research should look to develop more effective ways to account for patient severity when measuring patient safety rates among hospitals with varying bed counts.

Conclusions: The size of rural hospitals and their bed counts may be important factors to consider when measuring patient safety, developing standards of care recommendations, and in the implementation and testing of patient safety interventions.