Comparison of access to services in rural emergency departments in Quebec and British Columbia

Abstract

Introduction: Although emergency departments (EDs) in Canada's rural areas serve approximately 20% of the population, a serious problem in access to health care services has emerged. Objective: The objective of this project was to compare access to support services in rural EDs between British Columbia and Quebec. Methods: Rural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities (using the rural and small town definition from Statistics Canada). Data were collected from ministries of health, local health authorities, and ED statistics. A telephone interview was administered to collect denominative user data statistics and determine the status of services. Results: British Columbia has more rural EDs (n 5 34) than Quebec (n 5 26). EDs in Quebec have higher volumes (19,310 versus 7,793 annual visits). With respect to support services, 81% of Quebec rural EDs have a 24/7 on-call general surgeon compared to 12% for British Columbia. Nearly 75% of Quebec rural EDs have 24/7 access to computed tomography versus only 3% for British Columbia. Rural EDs in Quebec are also supported by a greater proportion of intensive care units (88% versus 15%); however, British Columbia appears to have more medevac aircraft/helicopters than Quebec. Conclusions: The results suggest that major differences exist in access to support services in rural EDs in British Columbia and Quebec. A nationwide study is justified to address this issue of variability in rural and remote health service delivery and its impact on interfacility transfers and patient outcomes.

Portrait of rural emergency departments in Québec and utilization of the provincial emergency department management Guide: cross sectional survey

“…Overall; these EDs treat more than 400 000 patients annually. In contrast to our preliminary data from other provinces in Canada, Québec’s rural EDs have high patient volumes and appear to offer more 24/7 local support services [ 14 , 15 ]. This study hypothesized that service attribution may reflect provincial policy and could be attributed in part to the existence of the provincial ED management Guide.…”

“…According to our pilot studies [ 14 ], the province of Québec seems to provide more comprehensive local access to services in rural EDs than that offered in other parts of Canada [ 15 ]. For example, less than 30 % of rural EDs in other provinces have 24/7 access to a local CT scanner, ICU or general surgeon.…”

Mobile emergency simulation training for rural health providers

“…Canadian rural emergency departments have limited access to medical consultants, surgeons, and intensive care support 3,4 , and these deficiencies vary dramatically between provinces 5,6 . Furthermore, physicians in rural hospitals may not have formal emergency training 7 , and nurses in remote or isolated communities may not have the necessary training or supports available for critically ill patients 8 …”

Differences in Access to Services in Rural Emergency Departments of Quebec and Ontario

“…It would have been interesting to estimate the populations and the size of the territories served by theses rural hospitals. Experience with this information is that it is difficult to reliably obtain and verify [ 15 , 41 – 43 ].…”

“…However, the actual level of services offered in rural EDs in Canada is unclear and despite a position paper on the subject by the CAEP in 1997 [ 13 ], there has been minimal research in rural emergency care issues. Our preliminary research suggests important interprovincial discrepancies in access to emergency support services that requires further investigation [ 14 , 15 ].…”