title: Supporting rural community-based critical care.
abstract: OBJECTIVE
  The ageing population, changing societal expectations and medical workforce shortages have created an unprecedented demand for intensive care services. This review describes the challenges to supporting rural-based critical care and discusses potential solutions for ensuring not only that rural patients receive a comparable level of care to their metropolitan counterparts, but also that patient outcomes are equivalent.
  
  
  RESULTS
  The ability of rural hospitals to deliver a high-quality, intensivist-led service depends on implementing a variety of strategies including: promoting recruitment and retention of specialist medical and nursing staff; ensuring appropriate, timely access to medical specialist-led retrieval services; exploring alternate modes of providing access to critical care physicians; expanding telemedicine opportunities; establishing clinical links between rural and metropolitan hospitals with opportunities for staff rotations, protocol sharing, and combined safety and quality, educational and research activities.
  
  
  CONCLUSIONS
  A number of solutions for supporting critical care in rural communities exist. None of these strategies are stand-alone solutions, nor are they universally applicable. Individual healthcare regions need to implement different strategies depending on local requirements and resources. Ultimately, lobbying for productive changes to healthcare policy will ensure the long-term viability of rural critical care.
authors.affiliation: Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, South Australia, Australia. sandra.peake@nwahs.sa.gov.au
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Peake
authors.forename: Nathan
authors.initials: N
authors.lastname: Judd
mesh_terms: D001315:Australia; D003153:Community Health Services; D003422:Critical Care; D016638:Critical Illness; D003695:Delivery of Health Care; D006801:Humans; D007362:Intensive Care Units; D019035:Rural Health Services; D017216:Telemedicine / Q000458:organization & administration*