Rural hospital emergency departments, no place for comprehensive primary health care

Ms Anne Neilson1,2, Prof Sabina  Knight1, Dr Yaqoot Fatima1, Dr Isabelle Skinner1

1James Cook University, Centre For Rural And Remote Health, Mount Isa, Australia,

2Queensland Health, Mount Isa, Australia


In Australia, hospital emergency departments are established to offer urgent care. When non-urgent patients present at the ED they may face long waits, eventually being seen only for their immediate concern.

The aim of our study was to identify modifiable patient, clinician and system factors leading to non-urgent (category 4 and 5) patients attending the emergency department of a rural hospital for care.

This mixed methods study reviewed a random sample of charts of non-urgent care patients from 2016. Focus groups and interviews were conducted with clinicians in the emergency department, community health and in primary care. In addition, 400 patients attending the emergency department who received a triage score of 4 or 5 were offered to complete a survey in 2018.

The results of our study showed, even in rural areas, health systems are complex for patients to navigate. People with poor health literacy are unclear about what tests will be required to diagnose their condition. Many patients catastrophize symptoms based on a web search or advice from a relative or friend. Health care providers set up compensatory processes such advising patients to “come back if they are worried” or compensate for lack of time available by admitting patients to short stay thus reinforcing the patient’s view that their condition is “serious”. Despite considerable time spent in the place of care, patients are not provided a referral to their GP and are not assisted to set up a relationship with a GP practice.

Improved patient health literacy, information on GP services including opening times and support to link with primary care services will reduce unnecessary presentations at the emergency department and improve primary health care. Collocating services such as pharmacy, radiology and pathology will reduce the transport burden where public transport is poor.


Anne Neilson is the Executive Director of Nursing Queensland Health and is Manager of the Nurse Navigator Program for Mount Isa and the Queensland Western Region including Rural and Remote. Anne’s passion is to enable people with complex conditions to seamlessly navigate the health system. She has lived and worked in Mount Isa over many years.