Small rural emergency services can electronically collect accurate episode-level data: A cross-sectional study

Small rural emergency services (SRES), unlike larger emergency departments, seldom collect clinical and administrative data about every patient they manage.

Samantha Dawson, Tim Baker, and Scott Salzman studied six SRES that collected this type of detailed data for 12 months.

The SRES were able to collect accurate and mostly complete electronic episode-level data for 12-months with four hours per week of support. This study provides starting data accuracy benchmarks for specific fields collected in SRES and could be used to inform decisions about widespread electronic data collection across these services.

Access article on publisher’s site

Dawson SL, Baker T, Salzman S. Small rural emergency services can electronically collect accurate episode-level data: A cross-sectional study. Aust J Rural Health. 2015, Apr;23(2):107-11.

Small rural hospitals are little in size, not importance (part one)

Small rural emergency departments are said to be not worth worrying about. They see too few patients. Is that really true? We decided to look at what was happening in our state of Victoria in Australia.

The Australian Hospital Statistics 2012–13 reports that there are 621 hospital-based emergency care facilities of some size and sort in Australia. 204 are what has been traditionally thought of as emergency departments – in metropolitan and large regional centres. The Australasian College for Emergency Medicine accredits about 180 of these for training. 469 are smaller, mostly rural, facilities.

I would love to describe the activity at these small rural facilities for you but, I can’t do it easily, because almost no data is collected from these 469 facilities. Large emergency departments submit episode level data on every patient they see – demographics, diagnosis, waiting times, disposition. Small emergency facilities often don’t have to submit anything but a count of how many people went through the door each year.

So we decided to collect some episode level data. There is no point being a Centre for Rural Emergency Medicine if you don’t even know what is going on. We created the SHED project – the Small Hospital ED project. We aimed to collect full episode level data from six small rual emergency departments. It wasn’t as easy as we expected. Some were still writing patient names in big old books. We put an emergency department IT system at each hospital, we took all the nurses through triage training, we educated the staff, we employed research assistants for over 12 months at each site, we audited about 10% of the patient notes.

The project ran from Feb 2011 until Jan 2012 and collected full episode level data from over 20,000 patients. We then expanded the project with the help of the Activity Based Funding Project at the Victorian Department of Health. We ran all our research queries through the data for all larger Victorian Emergency Departments over the same time, and we obtained the simple counts of patients presenting to Victoria’s other small rural emergency facilities over the same period. We think Victoria is a good state to study for this project as it is a small and fairly urban and centralised state. It is unlikely to exagerate the importance of rural hospitals.

So could we answer the thought that there are not many small hospital emergency facilities and they don’t see many patients.? We think we have something to add.

Vic Emergency facilities

This is Victoria’s public emergency system represented with each icon scaled to the average number of emergency presentations seen in each class.

It is certainly true that metropolitan hospitals are bigger. They see on average 46,000 presentations each year (some are much bigger), and large regional hospitals average 42,000. Subregional hospitals see 17,000 and small rural hospitals 3,000.

You will notice though, that the number of hospitals goes the other way. There are 22 metropolitan emergency facilities compared to 62 rural emergency facilities- 45 of them are at small rural hospitals.

So can we multiply things to see where patients are seen? Yes we can.

Victorian emergency presentations

Over a third of emergency department presentations in an urban state like Victoria are to a rural, regional, or remote emergency facility; one million metro, half a million rural. That means there are almost half as many reasons for Australasian College for Emergency Medicine to be a rurally-based college with a metro committee as a metro-based college with a rural, regional and remote committee.

And even the smallest emergency facilities, like some of those I work at, see 8% of the total presentations, or 140,000 per year. That means that the sector sees many more presentations Victoria’s largest single emergency department ED. When combined, at least in the number of presentations, small rural emergency facilities are big enough to be important.

(To be continued in part two)

Small rural emergency services still manage acutely unwell patients

Australian small rural emergency services need to be prepared to manage diverse problems and urgent patients.

Dr Tim Baker and Samantha Dawson conducted a study that collected 12-months worth of episode-level data from 6 small rural emergency departments in Victoria’s south-west.

They found that a wide range of problems presented and that most of the common procedures were performed. Most importantly, almost 6% of 14318 emergency patients were in the two most urgent triage categories.

Read more: Access article on publisher’s site

Baker T, and Dawson SL. Small rural emergency services still manage acutely unwell patients: A cross-sectional study [Internet]. Emergency Medicine Australasia. 2014;26(2):131-138.Available from:

Small Hospitals Emergency Database (SHED) project results for the first quarter of 2011

April 2011

The first quarter SHED project results are currently being extracted for the 6 participating Emergency Departments. Between January and March close to 5000 people presented to an Emergency Department and saw a clinician. Overall the patient gender breakdown was fairly even, and weekdays saw higher patient volumes than weekends.  When we have extracted a full years’ worth of data we will be able to determine trends in ED presentation. Over the next month the project team will be visiting participating hospitals to feed back the first quarter findings to the ED staff. We would like to thank the hospitals and staff for their continuing participation and we look forward to our next visit.

Small Hospitals Emergency Database (SHED) project begins data collection

February 2011

The SHED project is going full steam ahead with its data collection phase underway having started in January 2011. This phase of the project captures 12 months of emergency department data across six rural hospital locations. The data entered into the system will be used to accurately describe what happens in small rural emergency departments. We have had a high level of enthusiasm from participating hospital emergency departments and they are all entering their data with a high level of data accuracy.

Small Hospitals Emergency Database (SHED) project has employed 6 research assistants

December 2010

Six new casual research assistants have been hired to support the SHED project at each of the participating hospital locations. The research assistant role is central to the success of the data gathering phase of the project. Our research assistants will be helping hospital emergency department staff to understand the project requirements for data entry accuracy, along with training and providing support. CREM are pleased to announce and welcome our latest recruits: Nicola Taylor (Portland), Jenny Foster (Heywood), Margaret Tesselaar (Timboon),   Grant Holmes (Camperdown), Carolyn Crowe (Moyne) and Heather Hicks (Terang).