Open and Closed Models of Emergency Care: Navigating Change in Rural Hospitals

Emergency physicians are increasingly stepping into new roles in rural hospitals, where they may encounter unfamiliar service structures, blurred lines of responsibility, and conflicting expectations. The concept of open versus closed emergency department models, originally developed in intensive care medicine, provides a useful framework for navigating these challenges. In an open model, the emergency department is embedded within the broader hospital service, with clinical responsibility retained by senior decision makers outside the department. In a closed model, emergency physicians assume primary responsibility for patient care. Transitions to closed models should be implemented in stages to avoid disruption and support team cohesion. Both open and closed models are valid approaches, and each functions best when clinicians collaborate with mutual respect and shared purpose.