How do you define small-town hospital?

Where I work is relatively considered a small-town hospital. So what is a small town hospital? How is a small-town hospital any different than any other hospital? Are all so called small-town hospitals the same; do things operate the same?

Where I work there are 64 registered hospital beds. Actually, they just closed down the psyche unit, so that eliminates about ten. So, we are down to 54. And some of the remaining rooms are offices. So, is a small town hospital defined as a hospital with less than 100 beds? Can we define it that way. 

I live just outside the city. The City has a population of just outside 10,000. The total number of people in the entire county is about 60,000. The region is set up in such a way that there is a county east, north, and south of us. 

Shoreline (fake name I have always used) is a port city: Lake Michigan is to the west of us. Unlike the city 20 minutes to the North of us, our hospital is centrally located in such as way that we draw in quite a few patients from these surrounding counties. This makes Shoreline quite a bit busier than that hospital to our North. 

I know they are less busy than us, because I worked there and my friends work there. When I worked there all I did was sit and wait for something to happen. Okay, it was that slow. So, is small-town defined by regional population? Does a population of, say, less than 100 define small-town? Or is it defined by how busy you are?

If it's defined by population, then Shoreline is a small-town hospital today just as it was in 1997 when I started working here. However, if it's defined by how busy you are, then Shoreline used to be something else -- something bigger -- and is now considered a small-town hospital. I say this because we used to be very busy most of the time, now we are very busy very little of the time (I can delve into the reason why in a future post). 

At Shoreline we used to be very busy. At hospital-just-north-of us they have never been busy. Okay, so that makes us bigger than them. So, are they small-town and we bigger-town, or medium-town. And another hospital about two hours east of us is probably busier than us, as they have a college to deal with. So, are they considered even-bigger town hospital? 

Our critical care unit holds six patients. When I first started working for Shoreline in 1997, we used to have a vent on a regular basis. In fact, I remember quite a few days we had five, maybe even six, vents. And there was always someone on the vent long-term. 

Those days are gone. The reason is a story for another day. Today, most of the patients in our CCU are probably step-down patients at a larger hospital, or a city hospital. So, the acuity of our patients is not what it used to be. People with heart attacks are immediately shipped. Neuro patients are shipped. Traumas are shipped. Kids, for the most part, are shipped. They go to the experts at the larger hospitals. 

Basically, if you want to put it this way, we are an adult hospital. I mean, that's basically what a small-town hospital is these days. And if you really want to get specific, we specialize in your common surgeries and basic medical issues. That's pretty much it these days. 

For instance, we take care of people in the end stages of COPD to help them get over their flare-ups. We take care of patients with heart failure. We give them lasix. Our doctors order lots of breathing treatments (Not because they are needed, but because respiratory therapists need something to justify their existence). 

Sure, there's a few other things we do. We have an occasional kid. We have an occasional broken bone. We have an occasional diabetic. We have an occasional asthmatic. We have an occasional person with cystic fibrosis (although it's been a long time). We basically, as a respiratory therapy department, dole out breathing treatments for pneumonia and heart failure. We treat that audible wheeze caused by fluid overload with more fluid. 

So, back to the question: what is a small-town hospital? How do we define it? I personally think the definition has changed in the 20 years I've been doing this. Do we define it by geography (less than, say, 60,000 people in the surrounding county? Do we do it by patient load: fewer than 100 beds?  

So, how do you define small town hospital?