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

Abstract

BackgroundRural emergency departments (EDs) constitute crucial safety nets for the 20 % of Canadians who live in rural areas. Pilot data suggests that the province of Québec appears to provide more comprehensive access to services than do other provinces. A difference that may be attributable to provincial policy/guidelines “the provincial ED management Guide”. The aim of this study was to provide a detailed description of rural EDs in Québec and utilization of the provincial ED management Guide.MethodsWe selected EDs offering 24/7 medical coverage, with hospitalization beds, located in rural or small towns. We collected data via telephone, paper, and online surveys with rural ED/hospital staff. Data were also collected from Québec’s Ministry of Health databases and from Statistics Canada. We computed descriptive statistics, ANOVA and t-tests were used to examine the relationship between ED census, services and inter-facility transfer requirements.ResultsA total of 23 of Québec’s 26 rural EDs (88 %) consented to participate in the study. The mean annual ED visits was 18 813 (Standard Deviation = 6 151). Thirty one percent of ED physicians were recent graduates with fewer than 5 years of experience. Only 6 % had residency training or certification in emergency medicine. Teams have good local access (24/7) to diagnostic equipment such as CT scanner (74 %), intensive unit care (78 %) and general surgical services (78 %), but limited access to other consultants. Sixty one percent of participants have reported good knowledge of the provincial ED management Guide, but only 23 % of them have used the guidelines. Furthermore, more than 40 % of EDs were more than 300 km from levels 1 to 2 trauma centers, and only 30 % had air transport access.ConclusionsRural EDs in Québec are staffed by relatively new graduates working as solo physicians in well-resourced and moderately busy (by rural standards) EDs. The provincial ED management Guide may have contributed to this model of service attribution. However, the majority of rural ED staff report limited knowledge or use of the provincial ED management Guide and increased efforts at disseminating this Guide are warranted.

The Quebec emergency department guide: A cross-sectional study to evaluate its use, perceived usefulness, and implementation in rural emergency departments

“…In rural settings, these physicians most often provide a full scope of services (clinic, hospitalist, obstetrics, etc.). 20 Leadership positions are traditionally of low interest for clinical physicians. 23 Moreover, our results indicated that EDD have the least seniority in their establishments as compared with other management categories of interest.…”

“…The study constituted one component of a larger evaluative and descriptive study of rural EDs in Quebec and the use of the QEDMG. 12,20 Data were collected from directors of professional services (DPS), directors of nursing services (DNS), head nurses (HN), and emergency department directors (EDD). Eligible participants who worked in a rural hospital in the province of Quebec were 18 years of age or older and had worked full-time in their current position for a minimum of 6 months.…”

Improving delivery of care in rural emergency departments: a qualitative pilot study mobilizing health professionals, decision-makers and citizens in Baie-Saint-Paul and the Magdalen Islands, Québec, Canada

“…Baie-St-Paul hospital was selected as it was located relatively close (92 km) to the research team and to a level I trauma centre. It had also successfully participated in our initial studies on rural emergency care [5,19,20]. Finally, the principal investigator had previously worked as a locum doctor in this ED and thus knowledge of local stakeholders was perceived as a facilitator in the context of this pilot study.…”

“…primary healthcare) is limited and where individuals have lower incomes, less education, less healthy lifestyles, higher mortality rates and shorter life expectancy compared to people living in urban areas [1][2][3][4]. Rural EDs face complex challenges in delivering accessible, quality and efficient services due to their long distance from referral centres, difficulties recruiting and retaining staff, limited access to specialists, and unequal presence of modern infrastructures [2,5,6]. These challenges require solutions tailored to rural and remote contexts.…”

The challenges of measuring quality-of-care indicators in rural emergency departments: a cross-sectional descriptive study

“…14 The primary objective of this study was to investigate the feasibility of measuring the quality-of-care indicators defined by Schull and colleagues 12 in rural emergency departments in Quebec and to identify potential barriers to implementing the indicators. The study is a substudy of a larger cross-sectional multicentre research project 4,15 ( Figure 1). …”