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BackgroundThe aim of this rapid knowledge synthesis was to provide relevant research evidence to inform the implementation of a new health service in Nova Scotia, Canada: Collaborative Emergency Centres (CECs). CECs propose to deliver both primary and urgent care to rural populations where traditional delivery is a challenge. This paper reports on the methods used in a rapid knowledge synthesis project to provide timely evidence to policy makers about this novel healthcare delivery model.MethodsWe used a variety of methods, including a jurisdictional/scoping review, modified systematic review methodologies, and integrated knowledge translation. We scanned publicly available information about similar centres across our country to identify important components of CECs and CEC-type models to operationalize the definition of a CEC. We conducted literature searches in PubMed, CINAHL, and EMBASE, and in the grey literature, to identify evidence on the key structures and processes and effectiveness of CEC-type models of care delivery. Our searches were limited to published systematic reviews. The research team facilitated two integrated knowledge translation workshops during the project to engage stakeholders, to refine the research goals and objectives, and to share interim and final results. Citations and included articles were categorized by whether they addressed the CEC model or component structures and processes. Data and key messages were extracted from these reviews to inform implementation.ResultsCEC-type models have limited peer-reviewed evidence available; no peer-reviewed studies on CECs as a standalone healthcare model were found. As a result, our evidence search and synthesis was revised to focus on core CEC-type structures and processes, prioritized through consensus methods with the stakeholder group, and resulted in provision of a meaningful evidence synthesis to help inform the development and implementation of CECs in Nova Scotia.ConclusionsA variety of methods and partnership with decision-makers and stakeholders enabled the project to address the limitations in the evidence regarding CECs and meet the challenge of identifying the best available evidence in a transparent way to meet the needs of decision-makers in a short timeframe.

Shared decision making (SDM), a collaborative process whereby patients and professionals make health care decisions together, is a cornerstone of ethical patient care. The patient-clinician communication necessary to achieve SDM depends on many factors, not the least of which is a shared language (sometimes with the aid of a medical interpreter). However, even when a patient and clinician are speaking the same mother tongue, the use of medical jargon can pose a large and unnecessary barrier. This article discusses how health care professionals can use "universal health literacy precautions" as a legal, practical, and ethical means to enhance SDM and improve health care outcomes. Case of Language Barrier's Impact on Patient AutonomyPatient X, a 56-year-old construction worker, visits the emergency department (ED) with pain and swelling in his right calf. He can walk on his leg with a limp and considers the pain to be bearable. He would prefer to just "power through" whatever is causing the discomfort. This is his first ED visit. He is here to placate his wife, who was alarmed at the progression of the swelling over the last 24 hours.A physical exam reveals a slightly elevated temperature of 99 degrees and blood pressure of 150/110. Blood cultures, a creatine phosphokinase (CPK) test, and a Creactive protein (CRP) test are ordered. When asked about any previous trauma to his leg, Patient X is confused. Has he had "trauma"? He considers himself a calm person, not easily alarmed or "traumatized." He asks the physician (Dr. Y) why they need his blood and is told that the cultures may reveal the agent or pathogen responsible for his condition. Patient X is becoming alarmed. To him, an "agent" sounds like a person. A "pathogen" sounds like a "psychopath" but it can't mean that, except the doctor said something about the "culture." Dr. Y is running behind; it will be at least two hours before she can return with the bloodwork results to confirm her diagnosis, prescribe appropriately, and either discharge or admit Patient X. This leaves Patient X with two hours to worry and try to explain the situation to his wife over the phone.