Rural emergency departments : a systematic review to develop a resource typology relevant to developed countries

Objective: Despite low patient numbers, rural emergency departments have a similar diversity of case presentations as urban tertiary hospitals, with the need to manage high-acuity cases with limited resources. There are no consistent descriptions of the resources available to rural emergency departments internationally, limiting the capacity to compare clinical protocols and standards of care across similarly resourced units. This review aimed to describe the range of human, physical and specialist resources described in rural emergency departments in developed countries and propose a typology for use internationally. Design and setting: A systematic literature search was performed for journal articles between 2000 and 2019 describing the staffing, access to radiology and laboratory investigations, and hospital inpatient specialists. Results: Considerable diversity in defining rurality and in resource access was found within and between Australia, New Zealand, Canada and USA. Discussion: A typology was developed to account for (a) emergency department staff on-floor, (b) emergency department staff on-call, (c) physical resources and (d) access to a specialist surgical service. This provides a valuable tool for relevant stakeholders to effectively communicate rural emergency department resources within a country and internationally. Conclusion: The proposed five-tiered typology draws together international literature regarding rural emergency department services. Although further research is required to test this tool, the formation of this common language allows a base for effective communication between governments, training providers and policy-makers who are seeking to improve health systems and health outcomes.