The College has developed a unique set of standards and an audit tool to ensure that small rural hospitals are provided with the minimum resources they need to deliver emergency care to people living in remote areas. These fill an important gap in the country’s standards frameworks to protect those most poorly served by our nation’s health services.

For the over eighty percent of Australians living in our major centres it is can be easy to forget that Australia is a vast, hazardous and largely uninhabited continent

Approximately three million Australians live in or near small rural towns and around half a million of these are classified as being in remote areas.  Should these people need emergency medical assistance - help in the form of tertiary hospital facilities maybe a matter of many hours travel.  What is available in their nearest town is of the utmost importance.

In the outback, the need for emergency medical assistance is ever apparent whether it be in the face of cyclones or bushfires, obstetric emergencies, or farming accidents and the human impacts of isolation and rural contexts are stark. For example, compared to urban Australians people living in remote areas are five times more likely to die of vehicle accidents and 1.4 times more likely to die due to heart conditions.

In many of these situations small rural hospitals are the nearest location for emergency assistance.  The emergency departments of these hospitals are often staffed not by full-time emergency specialists but by Rural Generalist doctors, local general practitioners trained to provide hospital services in addition to their clinic-based work, working collaboratively with the local healthcare team.

To protect such local services and the people they assist the College developed its Minimum Standards for Small Rural Hospital Emergency Departments.  The standards articulate the minimum acceptable resourcing to ensure these people can access urgent care.  There is also a companion audit tool to assist small rural hospitals to conduct an assessment of their emergency medicine processes and resources to assist them in quality benchmarking and future planning.

The standards were developed as a direct result of calls from our members who work in situations such as these to protect their own local services. 

Small rural hospital emergency departments are under constant threat from successive rounds of health service cost-cutting initiatives.  They often suffer from being too small and remote to be defended within planning processes and too bespoke to neatly fit within the clinical frameworks used for budget planning. All too often it is only when it is too late that people recognise the need for the emergency equipment that is no longer there.

Hospitals such as these provide a unique model of care to meet an equally distinctive set of challenges and opportunities.  Achieving the best potential outcomes in terms of patient safety requires a fit-for-purpose approach which is realistic about resourcing frameworks and informed by an experience-based understanding of the nature of the practice context.

The standards draw upon the direct experience of our College’s members working in just such models of care. They were developed by a national team of doctors drawing on feedback garnered from national and international forums of doctors working in similar models of practice.

Our members across Australia have been encouraged to use these standards to self-assess their own local capacity.  The Standards have been adopted by a number of rural hospitals and in December were approved by the Tasmanian Health Service, Quality and Patient Safety Service.

The audit tool is an easy-to-use matrix which lists all the standards with a fill-in space against each for hospitals to identify their corresponding arrangements and plans. The tool is designed to be non-proscriptive, to provide a benchmark for rural/remote quality service, and to assist in future planning toward hospitals being adequately equipped and resourced to initially manage all presentations.

All rural health practitioners are encouraged to engage with their local hospital services to adopt these standards as a reference resource.