Sustaining Rural Access to Emergency Care through Collaborative Emergency Centres in Nova Scotia

Abstract

Collaborative Emergency Centres (CECs) were introduced in Nova Scotia in 2011 to address gaps in rural access to emergency care through enhanced primary care, urgent care, and interprofessional teams supported by remote physicians. In the wake of a historic election win by the New Democratic Party (NDP) in 2009, who promised to keep rural emergency departments open, a series of reports highlighted the troubles with small hospital emergency departments and suggested the development of CECs as a novel model of care. CECs aimed to improve access to emergency care in rural areas by matching the offered services to the needs of the community. The policy window for this reform was created through the convergence of a publicly recognized crisis in rural emergency department closures, a nationwide trend toward community-centred and interprofessional care models, and a historic NDP provincial government victory. Budgetary allocations and enabling legislation supported the development of the first set of four CECs for the province. Ministerial emergency department accountability reports and the Care Right Now report proclaimed the success of the CECs in reducing the number of hours of unplanned emergency department closures and in increasing rural communities' access to primary and emergency care. The CECs allowed Nova Scotia to provide access to around-the-clock emergency care at a greatly reduced cost, improved the work-life balance for rural physicians, and created a case for successful implementation of interprofessional teams in other environments.

Keywords

• Collaborative Emergency Centres
• Nova Scotia
• rural emergency departments
• interprofessional care
• telemedicine
• community paramedicine