Improving delivery of care in rural emergency departments: a qualitative pilot study mobilizing health professionals, decision-makers and citizens in Baie-Saint-Paul and the Magdalen Islands, Québec, Canada

Abstract

Background: Emergency departments (EDs) in rural and remote areas face challenges in delivering accessible, high quality and efficient services. The objective of this pilot study was to test the feasibility and relevance of the selected approach and to explore challenges and solutions to improve delivery of care in selected EDs. Methods: We conducted an exploratory multiple case study in two rural EDs in Québec, Canada. A survey filled out by the head nurse for each ED provided a descriptive statistical portrait. Semi-structured interviews were conducted with ED health professionals, decision-makers and citizens (n = 68) and analyzed inductively and thematically. Results: The two EDs differed with regards to number of annual visits, inter-facility transfers and wait time. Stakeholders stressed the influence of context on ED challenges and solutions, related to: 1) governance and management (e.g. lack of representation, poor efficiency, ill-adapted standards); 2) health services organization (e.g. limited access to primary healthcare and long-term care, challenges with transfers); 3) resources (e.g. lack of infrastructure, limited access to specialists, difficult staff recruitment/retention); 4) and professional practice (e.g. isolation, large scope, maintaining competencies with low case volumes, need for continuing education, teamwork and protocols). There was a general agreement between stakeholder groups. Conclusions: Our findings show the feasibility and relevance of mobilizing stakeholders to identify contextspecific challenges and solutions. It confirms the importance of undertaking a larger study to improve the delivery of care in rural EDs.

Phenomenological Study: Nurses' Experiences In Treating And Referring Penetrating Trauma Patients At The Arjasa Public Health Center, Sumenep Regency

“…Zulkifli et al (2019) said that nurses who work in remote health services try to provide actions according to patient needs even though with various limited facilities, this allows nurses who work to modify actions according to patient needs. Fleet et al (2020) said the challenge in providing emergency services at primary health centers is the limited facilities in the emergency unit.…”

A Pan-Canadian Narrative Review on the Protocols for COVID-19 and Canadian Emergency Departments

“…Unfortunately, these isolated rural departments struggle with recruiting and retaining staff, and often have limited access to medical equipment and resources needed to provide comprehensive care in rural communities. 18 As a result, it had been suggested that rural populations would face a disproportionate amount of disadvantages with COVID-19, versus Canadians living in urban settings. 17 This was largely attributed to the fact that rural Canadians generally have worse health status, leading to an increase in Intensive Care Unit (ICU) admissions and increase mortality compared to urban populations.…”

Translating Emergency Knowledge for Kids (TREKK): using research evidence to improve outcomes for children and families in emergency departments across Canada

“…Children have unique healthcare needs due to physiological, development and psychological differences. ED teams in these general ED settings have identified gaps in accessing pediatric-specific training and resources, including opportunities for hands-on practice during courses or training experiences [2][3][4]. Moreover, they have expressed concerns in maintaining pediatric expertise and competencies particularly if they do not often treat children or certain pediatric conditions [2,4].…”

“…ED teams in these general ED settings have identified gaps in accessing pediatric-specific training and resources, including opportunities for hands-on practice during courses or training experiences [2][3][4]. Moreover, they have expressed concerns in maintaining pediatric expertise and competencies particularly if they do not often treat children or certain pediatric conditions [2,4]. These concerns are well-founded; the gap in pediatric care between pediatric and general EDs has been associated with a disparity in health outcomes [5].…”