School of Population and Public Health, CAREX Canada, University of British Columbia, Vancouver, BC, Canada.
Department of Geography and Planning, University of Toronto, Toronto, ON, Canada.
CJEM. 2023 Mar;25(3):218-223. doi: 10.1007/s43678-023-00460-y. Epub 2023 Jan 31.
Access to emergency medical care in Ontario has been under stress, mainly due to a lack of human resources (staffing of nurses and doctors). Over the past year, several emergency departments in Ontario have closed. Some of these closures are nightly, while others have closed for weeks at a time, leaving Ontario residents without access to emergency medical care which can lead to poor or more severe outcomes. The purpose of this paper was to examine how closures of ED's in Ontario have influenced potential access to emergency medical care.
We performed population-level geographic information systems (GIS)-based analysis of potential access to ED hospitals in Ontario. The number of people with access to an ED was calculated when all ED's in Ontario were open, then recalculated with the 14 ED closures. Access was defined by ground travel with 30 min, 45 min, and 60 min travel times used for analysis. Differences in the number of people at the census block level who potentially lost access were compiled and examined by census subdivision.
If all 14 ED's had closed at the same time, there would be 35,808 people at 30 min, 15,018 at 45 min, and 12,131 at 60 min travel times in Ontario who lost access to ED care. Certain areas of the province saw more significant decreases in ED access. At 45 min travel times, nearly 2000 people in Central Frontenac lost access (44% of population), while 7298 people in Cochrane (North Part) lost access (20% of population).
ED closures have led to decreases in potential access to emergency care for predominantly rural populations. Health human resource recovery strategies must focus on areas where lack of overlap exists.
安大略省的紧急医疗服务一直面临压力，主要是由于人力资源（护士和医生的人员配备）不足。在过去的一年中，安大略省的几个急诊部门已经关闭。其中一些关闭是夜间关闭，而另一些则一次关闭数周，导致安大略省居民无法获得紧急医疗服务，这可能导致治疗效果不佳或更严重的后果。本文旨在研究安大略省急诊室关闭如何影响紧急医疗服务的潜在获得。
我们使用人口地理信息系统（GIS）对安大略省急诊医院的潜在可达性进行了基于人群的分析。当安大略省所有急诊室开放时，计算了有急诊室可去的人数，然后又在考虑到 14 家急诊室关闭的情况下重新计算了这一人数。通过 30 分钟、45 分钟和 60 分钟的地面旅行来定义可达性。根据普查分区汇编并检查了在普查街区层面潜在失去可达性的人数差异。
如果所有 14 家急诊室同时关闭，那么在 30 分钟、45 分钟和 60 分钟的旅行时间内，安大略省将有 35808 人无法获得急诊护理，15018 人无法获得 45 分钟的急诊护理，12131 人无法获得 60 分钟的急诊护理。该省某些地区的急诊室可及性下降幅度更大。在 45 分钟的旅行时间内，中 Frontenac 有近 2000 人失去了急诊室的可达性（占人口的 44%），而 Cochrane（北部）有 7298 人失去了急诊室的可达性（占人口的 20%）。
急诊室关闭导致主要是农村地区的紧急护理潜在可达性下降。卫生人力资源恢复策略必须侧重于缺乏重叠的地区。
