A northern, rural or remote town.

Policy Guidance on Emergency Department Closures in Northern, Rural and Remote Regions

June 2023


On February 1, 2023, Healthcare Excellence Canada convened diverse participants from nine provinces and territories to explore policy options for improving emergency department care and addressing closures. Patient partners, frontline providers, health leaders, regulatory bodies, national associations and policy-makers in government all joined in the collaborative discussion. This report synthesizes these discussions and highlights opportunities for responsive ways to deliver care to residents of northern, rural and remote communities

The report presents three key insights about how to prevent or mitigate emergency department  closures in these communities:

  1. A stable, experienced and sustainable workforce: Strategies to support communities in training, retaining and supporting their workforce can contribute to avoiding service disruptions.
  2. Connections to timely and appropriate care: Supporting local health resources to build capacity in primary and community services can reduce pressures on emergency departments and ensure more timely access to appropriate care.
  3. Health service design that reflects community voices and new models of care: A co-design process facilitating locally driven solutions and expanding access to culturally safe services will help meet the needs of northern, rural and remote populations.

Why this work matters

The sustainability and stability of emergency department services in northern, rural and remote areas in Canada has been an issue for health leaders and health system planners for several decades. Changing demographics, sub-optimally connected health system structures, rising costs of providing care and challenges maintaining the health workforce have contributed to intermittent and sometimes permanent closures of emergency departments in small communities.

Smaller populations and smaller teams can make the sustainability of services more precarious, requiring creative solutions to optimize resources and support care needs. Solutions will require strategic investments, new roles and types of providers, close attention to the issue of recruiting international graduates and appropriate use of technology.

As health systems incorporate adaptations emerging from the pandemic, there is opportunity to catalyze creative approaches to the delivery of care. Agile leadership, in combination with an inclusive approach to innovation that focuses on the needs of communities, will assist in implementing responsive policies and practices.