Distribution and Accessibility of Hospital-Based Emergency Departments for Paediatric Patients in Rural and Remote Western Australia: A Geographic Analysis.

Abstract

Objective: This study examined the distribution of emergency departments relative to remoteness and socioeconomic disadvantage and explored service availability for children in non-metropolitan Western Australia.

Methods: We conducted a spatial analysis using the Australian Government datasets. Child population counts and emergency facility locations were integrated into Quantum Geographic Information System and classified by remoteness using the Modified Monash Model (MMM) and by area-level socioeconomic disadvantage using the Index of Relative Socioeconomic Disadvantage (IRSD). Buffer zones were generated around each facility to quantify the proportion of children residing within specified distance thresholds. Service availability was assessed using facility-to-child and bed-to-child ratios.

Results: Emergency department availability declined with increasing remoteness: MMM5 contained the largest share of facilities (42.6%), followed by MMM6 (31.2%) and MMM7 (26.2%). However, ratios appeared more favourable in very remote areas, with facility-to-child ratios improving from 1:848 (MMM5) to 1:741 (MMM7). Bed availability showed a similar pattern, ranging from 1:83 in MMM5 to 1:60 in MMM7. Socioeconomic analyses revealed a concentration of facilities and bed capacity in the most disadvantaged areas, with IRSD 1 hosting 57.4% of all facilities and 35.8% of total bed capacity.

Conclusion: Geographic and socioeconomic inequities in emergency care provision persist across rural and remote Western Australia. Apparent improvements in ratios in very remote areas are driven by low population density rather than greater service investment. These findings support a shift to needs-based paediatric emergency service planning, using remoteness and IRSD-stratified proximity and capacity measures to prioritise communities with the greatest access shortfalls.