title: Portrait of rural emergency departments in Québec and utilization of the provincial emergency department management Guide: cross sectional survey.
abstract: BACKGROUND
  Rural 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  A 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.
  
  
  CONCLUSIONS
  Rural 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.
authors.affiliation: Department of Family and Emergency Medicine Université Laval, Québec, QC, Canada. rfleet@videotron.ca.|Research Chair in Emergency Medicine Université Laval, CHAU Hôtel-Dieu de Lévis Hospital, Lévis City, QC, Canada. rfleet@videotron.ca.|CSSS Alphonse-Desjardins, Research Centre, Hôtel-Dieu de Lévis, 143 Wolfe Street, Lévis, Québec, G6V 3Z1, Canada. rfleet@videotron.ca.
authors.forename: Richard
authors.initials: R
authors.lastname: Fleet
authors.affiliation: Department of Family and Emergency Medicine Université Laval, Québec, QC, Canada.|Research Chair in Emergency Medicine Université Laval, CHAU Hôtel-Dieu de Lévis Hospital, Lévis City, QC, Canada.
authors.forename: Julien
authors.initials: J
authors.lastname: Poitras
authors.affiliation: Department of Family and Emergency Medicine Université Laval, Québec, QC, Canada.|Research Chair in Emergency Medicine Université Laval, CHAU Hôtel-Dieu de Lévis Hospital, Lévis City, QC, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Archambault
authors.affiliation: Research Chair in Emergency Medicine Université Laval, CHAU Hôtel-Dieu de Lévis Hospital, Lévis City, QC, Canada.
authors.forename: Fatoumata Korika
authors.initials: FK
authors.lastname: Tounkara
authors.affiliation: Department of Family and Emergency Medicine, Department of Emergency Medicine, University of Montreal, Hôpital du Sacré-Coeur de Montréal, Montréal, QC, Canada.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Chauny
authors.affiliation: Department of political science, Université Laval, Québec, QC, Canada.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Ouimet
authors.affiliation: Direction de l'analyse et de l'évaluation des systèmes de soins et services, Institut national de santé publique du Québec, Université du Québec à Rimouski, Rimouski, QC, Canada.
authors.forename: Josée
authors.initials: J
authors.lastname: Gauthier
authors.affiliation: Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada.
authors.forename: Gilles
authors.initials: G
authors.lastname: Dupuis
authors.affiliation: Research Chair in Emergency Medicine Université Laval, CHAU Hôtel-Dieu de Lévis Hospital, Lévis City, QC, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Tanguay
authors.affiliation: Centre for Primary Health Care and Equity of the University of New South Wales, New South Wales, Australia.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Lévesque
authors.affiliation: Departement of Emergency Medicine, CSSS de la Matapédia, Québec, QC, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Simard-Racine
authors.affiliation: McGill Research Chair, Family and Community Medicine, Montréal, QC, Canada.
authors.forename: Jeannie
authors.initials: J
authors.lastname: Haggerty
authors.affiliation: Department of Family Medicine and Emergency Medicine, Knowledge Transfer and Health Technology Assessment of the CHUQ Research Centre (CRCHUQ), Unité de Recherche Évaluative, Université Laval, Québec, QC, Canada.
authors.forename: France
authors.initials: F
authors.lastname: Légaré
mesh_terms: D000704:Analysis of Variance; D002568:Certification; D002983:Clinical Competence / Q000592:standards; D003430:Cross-Sectional Studies; D019468:Disease Management; D004635:Emergency Medicine / Q000592:standards / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000706:statistics & numerical data; D007902:Length of Stay; D010820:Physicians / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011792:Quebec; D019035:Rural Health Services / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D061665:Time-to-Treatment