Emergency department performance at a small rural hospital: an independent in-depth review

This study aims to provide a retrospective review of the recent performance of the emergency department of Cobram District Hospital, a small rural hospital located on the border of Victoria and New South Wales.

Retrospective review.

Small rural accident and emergency department.

All available data collected from the emergency department from the previous three financial years (July 2005 to June 2008) were compiled onto a computerised spreadsheet and analysed by two independent investigators.

Key performance indicators, including time for patient to be seen by a doctor and frequency of patient presentations to the emergency department.

Cobram District Hospital has fewer than 5000 patients presenting to the emergency department each year. 12 p.m. to 12 a.m. accounts for 69% of all presentations, with three notable time periods that experience most presentations. Life-threatening emergencies represented <3% of all presentations to the emergency department. Patients in triage categories 1-3 did not met Australasian triage scale (ATS)-suggested time for maximum waiting timing, while categories 4 and 5 well exceeded ATS standards.

The small size and lack of dedicated emergency department staff place restrictions on the ability of an unfunded rural hospital to match the performance of major metropolitan emergency departments. ATS guidelines should be revised to improve clarity and reflect the different performance capabilities between metropolitan and rural centres.