Patient displacement during recurrent rural emergency department service interruptions: a 5-year observational case...

Rural emergency departments (EDs) are essential access points for care in geographically remote communities. In Alberta, equitable access is increasingly challenged by recurrent rural ED service interruptions. This study aimed to characterize the impact of such service interruptions through a case study of a rural community hospital in southern Alberta (Index Site) with a high burden of service interruptions.

An observational analysis was conducted using national ambulatory care reporting system (NACRS) data from 2019 to 2023. ED visits by Index Site residents were extracted and compared against eight rural comparator communities without reported service interruptions. Service interruptions were identified from provincial public records. ED utilization, displacement to alternate facilities, and presentation characteristics were evaluated.

Between October 2021 and December 2023, Index Site experienced recurrent ED service interruptions totaling over 3400 h (142 days). During this period, the proportion of ED visits by Index Site residents occurring outside their local ED rose from 9.6% in 2019 to 40.3% in 2023. Compared to rural communities without service interruptions (called Open Sites), Index Site residents demonstrated significantly lower local ED utilization from 2021 to 2023, despite initially higher rates. Displacement patterns evolved: Open Site B absorbed 60.2%-63.5% of displaced visits from 2019 to 2021, then declined during service interruption periods, while Open Site A increased from 12.6% of displaced visits in 2020 to 62.5% in 2023. Canadian triage acuity scale (CTAS) distributions and physician initial assessment rates during service interruption intervals showed ongoing ED utilization, despite reported service interruptions.

ED service interruptions in Index Site were associated with sustained patient displacement, underscoring the essential role of rural EDs and the strain placed on neighboring centers. This study presents a reproducible framework for evaluating rural ED service interruptions and highlights the need for transparent, province-wide reporting to inform health policy and emergency care planning.