title: A descriptive study of access to services in a random sample of Canadian rural emergency departments.
abstract: OBJECTIVE
  To examine 24/7 access to services and consultants in a sample of Canadian rural emergency departments (EDs).
  
  
  METHODS
  Cross-sectional study-mixed methods (structured interview, survey and government data bases) with random sampling of hospitals.
  
  
  METHODS
  Canadian rural EDs (rural small town (RST) definition-Statistics Canada).
  
  
  METHODS
  28% (95/336) of Canadian rural EDs providing 24/7 physician coverage located in hospitals with acute care hospitalisation beds.
  
  
  METHODS
  General characteristics of the rural EDs, information about 24/7 access to consultants, equipment and services, and the proportion of rural hospitals more than 300 km from levels 1 and 2 trauma centres.
  
  
  RESULTS
  Of the 336 rural EDs identified, 122 (36%) were randomly selected and contacted. Overall, 95 EDs participated in the study (participation rate, 78%). Hospitals had, on an average, 23 acute care beds, 7 ED stretchers and 13 500 annual ED visits. The proportion of rural hospitals with local access to the following 24/7 services was paediatrician, 5%; obstetrician, 10%; psychiatrist, 11%; internist, 12%; intensive care unit, 17%; CT scanner, 20%; surgeon, 26%; ultrasound, 28%; basic X-ray, 97% and laboratory services, 99%. Forty-four per cent and 54% of the RST EDs were more than 300 km from a level 1 and level 2 trauma centre, respectively.
  
  
  CONCLUSIONS
  This is the first study describing the services available in Canadian rural EDs. Apart from basic laboratory and X-ray services, most rural EDs have limited access to consultants, advanced imaging and critical care services. A detailed study is needed to evaluate the impact of these limited services on patient outcomes, costs and interfacility transport demands.
authors.affiliation: Department of Family and Emergency Medicine, Université Laval, Quebec City, Quebec, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Fleet
authors.forename: Julien
authors.initials: J
authors.lastname: Poitras
authors.forename: Julie
authors.initials: J
authors.lastname: Maltais-Giguère
authors.forename: Julie
authors.initials: J
authors.lastname: Villa
authors.forename: Patrick
authors.initials: P
authors.lastname: Archambault
keywords: Epidemiology; Health Services Administration & Management