title: The impact of transport of critically ill pediatric patients on rural emergency departments in Manitoba.
abstract: BACKGROUND
  Although the interfacility transport (IFT) of critically ill pediatric patients from rural to tertiary health centres may improve outcomes, the impact of IFTs on the rural referring centre is not known. The purpose of this study was to investigate how the IFT of critically ill children affects staffing and functionality of rural emergency departments (EDs) in Manitoba.
  
  
  METHODS
  In 2015, surveys were emailed to the medical directors of all 15 regional EDs within 2 hours' travel time from a tertiary pediatric hospital. The survey consisted of 9 questions that addressed baseline characteristics of the regional EDs and duration of ED staffing changes or closures due to IFT of critically ill pediatric patients.
  
  
  RESULTS
  Ten surveys were received (67% response rate); a regional ED catchment population of about 130 000 people was represented. Interfacility transport caused most EDs (60%, with an average catchment population of 15 000) to close or to alter their staffing to a registered nurse only. These temporary changes lasted a cumulative total of 115 hours.
  
  
  CONCLUSIONS
  Interfacility transport of critically ill pediatric patients resulted in ED closures and staffing changes in rural Manitoba. These findings suggest that long-term sustainable solutions are required to improve access to emergency care.
authors.affiliation: Section of Pediatric Intensive Care, Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital of Winnipeg, Winnipeg, Man.
authors.forename: Gregory
authors.initials: G
authors.lastname: Hansen
authors.affiliation: Section of Pediatric Emergency Medicine, Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital of Winnipeg, Winnipeg, Man.
authors.forename: Darcy L
authors.initials: DL
authors.lastname: Beer
authors.affiliation: Faculty of Health Disciplines, Athabasca University, Athabasca, Alta.
authors.forename: Jeff K
authors.initials: JK
authors.lastname: Vallance
mesh_terms: D002648:Child; D002669:Child Welfare / Q000706:statistics & numerical data*; D004631:Emergency Medical Service Communication Systems / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000458:organization & administration*; D006780:Hospitals, Rural / Q000458:organization & administration*; D006801:Humans; D008350:Manitoba; D010360:Patient Transfer / Q000706:statistics & numerical data*