title: Triage, treat and transfer: reconceptualising a rural practice model.
abstract: OBJECTIVE
  This article argues that the current model of emergency practice in rural Victorian hospitals, which relies heavily on visiting medical officers, needs to be reconceptualised if emergency services are to be supplied to rural communities.
  
  
  BACKGROUND
  Medical workforce shortages are manifesting in Victoria as a reduction in emergency care services from rural hospitals. The suggested alternative model of emergency care involves advancing nursing practice to enable a redistribution of clinical capacity across the health care team. Clinicians will need to work collaboratively and continuously negotiate their roles to meet the patient's and the clinical team's needs.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  This article is based on a review of the Victorian and Australian literature on the subject of Victorian health services and policy, emergency care, collaboration, communication and rural nurse scope of practice and roles. Emergency care activity was drawn from data held in the Victorian Emergency Management Dataset and personal communications between one of the authors and hospital executives in a small selection of rural hospitals in Victoria.
  
  
  RESULTS
  The evidence reviewed suggests that the current emergency practice profile of rural hospitals in Victoria does not reflect the reconceptualised model of rural emergency practice. Instead, only a small proportion of non-urgent presentations is managed by nurses without medical support, and the data suggest that metropolitan nurses are more likely to manage without medical support than rural nurses.
  
  
  CONCLUSIONS
  Reconceptualising rural emergency care in Victoria will require significantly greater investment in rural nurses' knowledge and skills to enable them to operate confidently at a more advanced level. Clinical teams that deliver emergency service in rural hospitals will be expected increasingly to work collaboratively and interprofessionally.
  
  
  CONCLUSIONS
  This article offers some directions for advancing nursing practice and strategies for improving interprofessional collaboration in the delivery of rural emergency care.
authors.affiliation: School of Nursing & Midwifery, Monash University, Churchill, Vic., Australia. elise.sullivan@dpar.com.au
authors.forename: Elise
authors.initials: E
authors.lastname: Sullivan
authors.forename: Karen
authors.initials: K
authors.lastname: Francis
authors.forename: Desley
authors.initials: D
authors.lastname: Hegney
mesh_terms: D001315:Australia; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006780:Hospitals, Rural / Q000458:organization & administration*; D017146:Models, Organizational; D010360:Patient Transfer; D010564:Personnel, Hospital / Q000600:supply & distribution; D024382:Professional Role; D014218:Triage