Comparison of rates of emergency department procedures and critical diagnoses in metropolitan and rural hospitals Rural and Remote Health 15: 3298. (Online) 2015 Available: http://www.rrh.org.au © JR Waymack, S Markwell, JC Milbrandt, TR Clark, 2015. A licence to publish this material has been given to James Cook University, http://www.rrh.org.au 2 Results: When comparing 22 766 219 rural ED visits to 97 267 531 metropolitan ED visits there were significant differences between the rates of

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... dures and critical diagnoses. For all procedures analyzed, the rate at which they were performed in the rural setting versus the metropolitan was significantly lower. The decreased performance rate in rural EDs compared to metropolitan EDs was greatest for ED procedures such as fracture reduction, endotracheal intubation and lumbar puncture. Overall, procedures were performed twice as often in metropolitan EDs as compared to rural EDs. Critical diagnosis rates also tended to be lower for rural EDs when compared to metropolitan EDs. This difference in identification of critical diagnosis rate was greatest for acute myocardial infarction, cardiac dysrhythmia and ischemic cerebrovascular accident. Conclusions: The rates of critical diagnoses are similar, but are still lower in rural EDs as a recent single-site study has shown. The lower rates of procedures and critical diagnoses in rural EDs confirm the concern that residents receiving a substantial portion of their training in rural EDs may not get sufficient experience in certain procedures or critical diagnoses. The benefits of a rural ED rotation must be weighed against the risk of lower procedure and critical diagnosis rates. The impact of a 1-3 month rotation in a rural ED on overall procedural competency and clinical experience cannot, however, be extrapolated, and further study is required to quantify this effect.