The importance of tailoring physicians’ trauma care training needs in rural environments

Tarighi, Payam; Sherman, Jill E.; Mian, Oxana; Nathens, Avery B.

doi:10.1503/cjs.002315

Cited by 7 publications

(5 citation statements)

References 4 publications

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“…Providers in this study reported how fatigue impacts documentation, directly affecting development and implementation of a TR. Training levels and experience of providers are known to impact care of injured patients [ 41 , 42 ]; existing literature aligns with that we found - that providers perceived junior doctors as being unreliable to perform proper documentation linked to the care provided. Some participants highlighted that the provision of care was not matching documentation; consequently, the patient would receive more care and less documentation, especially if the attending provider is senior.…”

Section: Discussionsupporting

confidence: 80%

Barriers and facilitators to implementing trauma registries in low- and middle-income countries: Qualitative experiences from Tanzania

Sawe

Sirili

Weber

et al. 2020

African Journal of Emergency Medicine

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Background The burden of trauma in low and middle-income countries (LMICs) is disproportionately high: LMICs account for nearly 90% of the global trauma deaths. Lack of trauma data has been identified as one of the major challenges in addressing the quality of trauma care and informing injury-preventing strategies in LMICs. This study aimed to explore the barriers and facilitators of current trauma documentation practices towards the development of a national trauma registry (TR). Methods An exploratory qualitative study was conducted at five regional hospitals between August 2018 and December 2018. Five focus group discussions (FGDs) were conducted with 49 participants from five regional hospitals. Participants included specialists, medical doctors, assistant medical officers, clinical officers, nurses, health clerks and information communication and technology officers. Participants came from the emergency units, surgical and orthopaedic inpatient units, and they had permanent placement to work in these units as non-rotating staff. We analysed the gathered information using a hybrid thematic analysis. Results Inconsistent documentation and archiving system, the disparity in knowledge and experience of trauma documentation, attitudes towards documentation and limitations of human and infrastructural resources in facilities we found as major barriers to the implementation of trauma registry. Health facilities commitment to standardising care, Ministry of Health and medicolegal data reporting requirements, and insurance reimbursements criteria of documentation were found as major facilitators to implementing trauma registry. Conclusions Implementation of a trauma registry in regional hospitals is impacted by multiple barriers related to providers, the volume of documentation, resource availability for care, and facility care flow processes. However, financial, legal and administrative data reporting requirements exist as important facilitators in implementing the trauma registry at these hospitals. Capitalizing in the identified facilitators and investing to address the revealed barriers through contextualized interventions in Tanzania and other LMICs is recommended by this study.

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Section: Discussionsupporting

confidence: 80%

Barriers and facilitators to implementing trauma registries in low- and middle-income countries: Qualitative experiences from Tanzania

Sawe

Sirili

Weber

et al. 2020

African Journal of Emergency Medicine

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“…Many rural EDs are staffed by physicians not board‐certified in emergency medicine or by advanced practice providers (e.g., physician assistants or nurse practitioners) with no real‐time on‐site physician supervision . Despite the increased prevalence of traumatic injury and trauma‐associated death in rural populations, severe trauma remains an infrequently treated condition in many low‐volume EDs, and many rural providers may be less comfortable with trauma management and care …”

Section: Discussionmentioning

confidence: 99%

“…24 Despite the increased prevalence of traumatic injury and trauma-associated death in rural populations, 2,3 severe trauma remains an infrequently treated condition in many low-volume EDs, and many rural providers may be less comfortable with trauma management and care. 25 Another reason for consultation for these patients is the significant administrative function that the telemedicine hub serves. In the telemedicine network, hub staff provide real-time nursing documentation for rural critically ill patients, enter orders in the rural hospital medical record, and arrange transfer by contacting receiving hospitals and emergency medical services agencies.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study

Mohr

Harland

Chrischilles

et al. 2017

Academic Emergency Medicine

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Emergency department-based telemedicine consultation is requested for the most severely injured rural trauma patients, especially with those with penetrating trauma, burns, and abnormal presenting vital signs. Telemedicine consultation was not independently associated with increased probability of transfer. Future work should evaluate how telemedicine impacts the timeliness of care and specific care interventions.

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“…In previous studies, rural physicians have expressed interest in managing patients with pediatric, orthopedic, vascular and blunt thoracic or abdominal trauma. 25 Although courses such as ATLS and the Rural Trauma Team Development Course (RTTDC) may bridge these knowledge gaps, it may not be realistic or feasible to take health care providers away from the sparsely served rural sites they service to provide training. Our study did not examine differences in hospitals that have RTTDC personnel at any point during or before the study period.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of trauma resources in rural northern Alberta identifies opportunities for improvement

Jiang¹,

MacLean

Yoon³

et al. 2020

cjs

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Background: The care of rural trauma patients in northern Alberta can be extremely challenging because of the vast geographic area, the limited access to health care facilities and the lack of adequate resources to manage severe injuries. Identifying gaps in equipment and personnel in rural centres can provide opportunities for improving the care of injured patients in these environments. We conducted a survey based on Canadian Accreditation Council quality indicators to evaluate trauma infrastructure and human resources in rural centres across northern Alberta. Methods: A standardized survey was developed to assess the availability of trauma-specific equipment and personnel across the prehospital and emergency department (ED) settings. The survey was distributed to 50 peripheral hospitals biannually from January 2017 to September 2018. Two-tailed paired t tests were used to evaluate changes in survey responses; a p value of less than 0.05 was considered statistically significant. Results: The survey response rate was 100%. By the end of the study period, there were significant improvements in the number of providers (p = 0.04), nurses (p = 0.01) and dedicated trauma resuscitation bays (p = 0.04) in the ED for managing injured patients. There were also significant increases in the availability of equipment, including advanced airway management tools (p = 0.02), rapid infusion devices (p = 0.02) and warmers (p = 0.04). Access to x-ray equipment (p = 0.03) and computed tomography (CT) scanners (p = 0.04) as well as equipment to support telehealth and teleconferencing (p = 0.04) increased during the study period. Access to, and supply of, blood products also increased significantly (p = 0.02) during the study period. Conclusion: Our study demonstrates that the trauma resources of rural health care centres may be evaluated in a standardized fashion centres, and the results point to opportunities to remedy gaps in equipment and personnel. Our methods may be applied to any trauma network that serves geographically large areas with a sparse distribution of health care facilities, to provide critical information for the optimization of resources in rural trauma. Contexte : Les soins aux patients victimes de traumatismes en région rurale dans le nord de l'Alberta peuvent être très difficiles en raison de la superficie de la région, de l'accès limité aux établissements de santé et du manque de ressources pour soigner adéquatement les blessures graves. En repérant les lacunes en équipement et en personnel dans les établissements en région rurale, on peut créer des occasions d'améliorer les soins aux patients blessés dans ces milieux. Nous avons mené un sondage fondé sur les indicateurs de qualité du Conseil d'accréditation canadien pour évaluer les infrastructures et les ressources humaines en traumatologie dans les établissements des régions rurales du nord de l'Alberta. Méthodes : Un sondage standardisé a été créé pour évaluer la disponibilité des équipements et des ressources humaines en traumatologie en contexte préhosp...

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The importance of tailoring physicians’ trauma care training needs in rural environments

Cited by 7 publications

References 4 publications

Barriers and facilitators to implementing trauma registries in low- and middle-income countries: Qualitative experiences from Tanzania

Barriers and facilitators to implementing trauma registries in low- and middle-income countries: Qualitative experiences from Tanzania

Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study

Evaluation of trauma resources in rural northern Alberta identifies opportunities for improvement

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