Working towards equity: An example of an <scp>emergency department</scp> project for Aboriginal and Torres Strait Islander health and cultural safety

Barnes, Deborah; Phillips, Georgina; Mason, Toni; Hutton, Jennie

doi:10.1111/1742-6723.14003

Cited by 3 publications

(15 citation statements)

References 8 publications

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“…28 Cultural safety is an essential component of patient safety, with medical schools and specialist medical colleges looking to embed it into curricula and an evergrowing body of literature displaying positive health equity outcomes for Aboriginal and Torres Strait Islander peoples following the implementation of various cultural safety initiatives within health services. [29][30][31][32][33] Despite this, there is still much work to be done. 34 Despite similar ED presentation profiles with respect to the 10 most common diagnoses and comparable presentations that required hospital admission observed in EDs located in major cities and regional areas, presentations to regional EDs were significantly less likely to be admitted to the hospital.…”

Section: Discussionmentioning

confidence: 99%

“…Aboriginal and Torres Strait Islander peoples have unique health, social and cultural requirements and experience multifaceted patient journeys, which need to be understood holistically by health practitioners 28 . Cultural safety is an essential component of patient safety, with medical schools and specialist medical colleges looking to embed it into curricula and an ever‐growing body of literature displaying positive health equity outcomes for Aboriginal and Torres Strait Islander peoples following the implementation of various cultural safety initiatives within health services 29–33 . Despite this, there is still much work to be done 34…”

Section: Discussionmentioning

confidence: 99%

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Casemix and performance of Australian emergency departments: A comparison of major city, regional and remote locations

Tatkovic,

Moore,

Lim

2023

Emerg Medicine Australasia

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ObjectiveEDs are an essential service, and higher rates of presentations per population are seen in regional and remote areas compared to major cities. Australia‐wide differences in utilisation and performance remain largely unknown.MethodsThis was a descriptive, retrospective epidemiological study analysing data collected via the National Non‐Admitted Patient Emergency Department Care Database managed by the Australian Institute of Health and Welfare. Data from all reporting public hospitals in Australia for the period between 1 July 2018 and 30 June 2019 were analysed. Reporting EDs were geographically categorised using the 2016 Australian Statistical Geography Standard – Remoteness Area.ResultsED presentations for the 293 reporting EDs were 8 352 192 (median 17 904, range 8–113 929), one‐third (33.09%, 95% CI 33.06–33.12) were outside major cities. Remote ED presentations were less likely to arrive by ambulance (12.13% [12.01–12.26]; major cites 28.07% [28.03–28.10]; regional 22.55% [22.50–22.60]) but more likely by police/correctional services vehicle (major cities 0.59% [0.58–0.60]; regional 0.71% [0.70–0.72]; remote 1.71% [1.66–1.76]). Presentations to remote EDs were more likely to leave without being attended by a health professional (5.29% [5.21–5.38]; major cities 3.93% [3.92–3.95]; regional 3.53% [3.51–3.55]). A larger proportion of admitted patients stayed at least 8 h in remote (21.83% [21.46–22.20]) and regional (21.52% [21.41–21.62]) EDs compared to major cities (19.82% [19.76–19.88]).ConclusionsOur study highlights ED utilisation, casemix and performance by location. The differences observed, especially areas of inequity and need for interventions, reiterate that imperative regional and remote EDs are appropriately resourced to support the communities they serve.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Casemix and performance of Australian emergency departments: A comparison of major city, regional and remote locations

Tatkovic,

Moore,

Lim

2023

Emerg Medicine Australasia

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“… Adequate flow from interpretation to conclusion? Overall appraisal Barnes, 2022 [ 16 ] Yes Yes Yes Yes Yes Unclear Yes No Unclear Yes Include Gadsden, 2019 [ 25 ] Yes Yes Yes Yes Yes No Unclear Yes Yes Yes Include Preisz, 2022 [ 26 ] Yes Yes Yes Yes Yes No No No Unclear Yes Include Carter, 2021 [ 27 ] Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Include Varcoe, 2022 [ 28 ] Yes Yes Yes Yes Yes No No No Yes Yes …”

Section: Methodsmentioning

confidence: 99%

“…Indigenous patients tend to have higher rates of emergency department (ED) visits [ 10 ], decreased length of ED stays [ 11 , 12 ], higher hospital admission rates [ 13 ], increased disease complexities [ 14 , 15 ] and incorrectly assigned lower triage scores [ 9 , 13 ]. The compounding factors increasing ED utilization include inadequate access to routine primary care, increased propensity for acute pathologies [ 15 ], and healthcare avoidance due to the significant anti-Indigenous biases present in our health system [ 16 , 17 ]. Considering these factors, EDs can be areas of health equity reform, providing an opportunity to increase the quality of Indigenous healthcare.…”

Section: Introductionmentioning

confidence: 99%

Improving Indigenous health equity within the emergency department: a global review of interventions

Marchand,

Squires,

Daodu

et al. 2024

Can J Emerg Med

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Introduction Indigenous health equity interventions situated within emergency care settings remain underexplored, despite their potential to influence patient care satisfaction and empowerment. This study aimed to systematically review and identify Indigenous equity interventions and their outcomes within acute care settings, which can potentially be utilized to improve equity within Canadian healthcare for Indigenous patients. Methods A database search was completed of Medline, PubMed, Embase, Google Scholar, Scopus and CINAHL from inception to April 2023. For inclusion in the review, articles were interventional and encompassed program descriptions, evaluations, or theoretical frameworks within acute care settings for Indigenous patients. We evaluated the methodological quality using both the Joanna Briggs Institute checklist and the Ways Tried and True framework. Results Our literature search generated 122 publications. 11 articles were selected for full-text review, with five included in the final analysis. Two focusing on Canadian First Nations populations and three on Aboriginal Australians. The main intervention strategies included cultural safety training, integration of Indigenous knowledge into care models, optimizing waiting-room environments, and emphasizing sustainable evaluation methodologies. The quality of the interventions was varied, with the most promising studies including Indigenous perspectives and partnerships with local Indigenous organizations. Conclusions Acute care settings, serving as the primary point of access to health care for many Indigenous populations, are well-positioned to implement health equity interventions such as cultural safety training, Indigenous knowledge integration, and optimization of waiting room environments, combined with sustainable evaluation methods. Participatory discussions with Indigenous communities are needed to advance this area of research and determine which interventions are relevant and appropriate for their local context.

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“… 7 8 Fear or mistrust in western healthcare structures has led many patients to avoid health services and only access care in emergency departments during highly acute situations. 9 Barriers reported as key reasons for delayed presentations include racism within the healthcare system, unavailability of Indigenous physicians and healthcare staff, and language barriers. 10 Further, Indigenous patients have a higher burden of disease and tend to present with more critical health concerns and suffer from higher rates of comorbidities such as type 2 diabetes, obesity and cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

Examining Indigenous emergency care equity projects: a scoping review protocol

et al. 2023

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IntroductionIndigenous peoples across the globe face inequitable access to high-quality care. Emergency departments are the first point of access for many Indigenous peoples and are the interface between the individual and the healthcare system. There is a reliance on emergency services due to a lack of primary healthcare, a history of mistreatment from providers and increased disease complexity. As such, a potential place for health equity reform is within these departments and other acute care settings. It is the purpose of this review to determine what projects have occurred that address emergency care inequities in four countries such as Australia, Canada, New Zealand and the USA and explore their successes and failures.Methods and analysisUsing search strategies developed with a research librarian, publications will be identified from indexed databases including Medline, Embase, Web of Science, Cochrane Central, CINAHL and Scopus. Grey literature will also be searched and scanned for inclusion. To be included in the review, articles must describe interventions developed to address Indigenous health equity occurring within emergency care settings. Articles will include both programme descriptions and programme evaluations and be quality appraised by analysing study design and Indigenous research methodologies.Ethics and disseminationThis review does not require ethics approval. This protocol describes a review that attempts to map Indigenous health equity interventions taking place within emergency care settings. It will contribute to Indigenous health scholarship and equity research. Results will be made available in multiple dissemination methods to ensure accessibility by researchers and community members.

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Working towards equity: An example of an emergency department project for Aboriginal and Torres Strait Islander health and cultural safety

Cited by 3 publications

References 8 publications

Casemix and performance of Australian emergency departments: A comparison of major city, regional and remote locations

Casemix and performance of Australian emergency departments: A comparison of major city, regional and remote locations

Improving Indigenous health equity within the emergency department: a global review of interventions

Examining Indigenous emergency care equity projects: a scoping review protocol

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