Portrait of trauma care in Quebec's rural emergency departments and identification of priority intervention needs to improve the quality of care: a study protocol

Fleet, Richard; Tounkara, Fatoumata Korika; Ouimet, Mathieu; Dupuis, Gilles; Poitras, Julien; Tanguay, Alain; Fortin, J. A.; Trottier, Jean-Guy; Ouellet, Jean; Lortie, G.; Plant, Jeff; Morris, Judy; Chauny, J.; Lauzier, François

doi:10.1136/bmjopen-2015-010900

Cited by 8 publications

(9 citation statements)

References 35 publications

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“…Fifty-nine hospitals met the eligibility criteria and were included in the analysis; 26 were rural EDs and 33 were urban trauma centres (figure 1). Of the 26 rural EDs, 18 were primary trauma centres (level 3), 6 were stabilisation centres (level 4), and 2 were not designated trauma centres by the Ministry of Health and Social Services 24…”

Section: Resultsmentioning

confidence: 99%

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Profile of trauma mortality and trauma care resources at rural emergency departments and urban trauma centres in Quebec: a population-based, retrospective cohort study

Fleet

Lauzier²,

Tounkara

et al. 2019

BMJ Open

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ObjectivesAs Canada’s second largest province, the geography of Quebec poses unique challenges for trauma management. Our primary objective was to compare mortality rates between trauma patients treated at rural emergency departments (EDs) and urban trauma centres in Quebec. As a secondary objective, we compared the availability of trauma care resources and services between these two settings.DesignRetrospective cohort study.Setting26 rural EDs and 33 level 1 and 2 urban trauma centres in Quebec, Canada.Participants79 957 trauma cases collected from Quebec’s trauma registry.Primary and secondary outcome measuresOur primary outcome measure was mortality (prehospital, ED, in-hospital). Secondary outcome measures were the availability of trauma-related services and staff specialties at rural and urban facilities. Multivariable generalised linear mixed models were used to determine the relationship between the primary facility and mortality.ResultsOverall, 7215 (9.0%) trauma patients were treated in a rural ED and 72 742 (91.0%) received treatment at an urban centre. Mortality rates were higher in rural EDs compared with urban trauma centres (13.3% vs 7.9%, p<0.001). After controlling for available potential confounders, the odds of prehospital or ED mortality were over three times greater for patients treated in a rural ED (OR 3.44, 95% CI 1.88 to 6.28). Trauma care setting (rural vs urban) was not associated with in-hospital mortality. Nearly all of the specialised services evaluated were more present at urban trauma centres.ConclusionsTrauma patients treated in rural EDs had a higher mortality rate and were more likely to die prehospital or in the ED compared with patients treated at an urban trauma centre. Our results were limited by a lack of accurate prehospital times in the trauma registry.

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Section: Resultsmentioning

confidence: 99%

“…We performed a retrospective cohort study of all trauma cases in Quebec between 2009 and 2013. The protocol for this study has been previously published 24. Data were collected from the Quebec Trauma Registry Information System (BDM-SIRTQ), a population-based registry under the Ministry of Health and Social Services.…”

Section: Methodsmentioning

confidence: 99%

Profile of trauma mortality and trauma care resources at rural emergency departments and urban trauma centres in Quebec: a population-based, retrospective cohort study

Fleet

Lauzier²,

Tounkara

et al. 2019

BMJ Open

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“…2,12,20,21 However, approximately 10% of rural communities in northern Alberta lie outside this guideline, 12 highlighting the challenges in covering the vast geography adequately. Even if closer, but potentially less wellequipped, hospitals are bypassed en route to facilities that provide higher levels of care, 17,22 it is not realistic to expect to transport patients directly to a level 1 trauma centre within 1 hour of injury in our system. Weather, geography and aircraft landing and refuelling specifications profoundly influence transport time.…”

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 ability to bring absent expertise into the trauma bay or operating theater provides opportunities for enabling better outcomes and serves as an excellent pedagogical environment as well. Emergency room protocols have evolved with the integration of new technologies that provide better outcomes and remote surgical proctoring [26,27]. Surgical skills are developed over an extensive educational program of residency, fellowship, and ongoing education, including simulations [28].…”

Section: Discussionmentioning

confidence: 99%

Telementoring and Teleproctoring in Trauma and Emergency Care

Doarn

Latifi

2016

Curr Trauma Rep

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Purpose of Review The use of telemedicine is long-standing, but only in recent years has it been applied to the specialties of trauma, emergency care, and surgery. We provide a review of its application in these disciplines. Recent Findings Despite being relatively new, the concept of teletrauma, telepresence, and telesurgery is evolving and is being integrated into modern care of trauma and surgical patients. The role of telementoring for trauma has not been addressed in clinical trials, yet there are consultations and advise on how to manage a critically ill patient, which is telementoring and teleproctoring. Advances in technology, including telemedicine and telepresence applications for trauma, emergency management, and intensive critical care, may be the solution that can reduce, eliminate, or ameliorate the gap in trauma care between rural and urban areas. There is a plethora of examples of the application of telepresence and telemedicine in these fields, although at the current stage, most are only simple examples of the progression of telemedicine in trauma care. Conclusion As the technology becomes more user friendly and less costly, the hope is that these modalities will become a norm, rather than an exception. What we need is for the trauma community to be creative in finding a sensible way to help both the patient and physician in the region or hospital where such resources are missing. In this review article, we address a number of elements, including historical notes of telesurgery and other studies pertaining to trauma and emergency care.

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Portrait of trauma care in Quebec's rural emergency departments and identification of priority intervention needs to improve the quality of care: a study protocol

Cited by 8 publications

References 35 publications

Profile of trauma mortality and trauma care resources at rural emergency departments and urban trauma centres in Quebec: a population-based, retrospective cohort study

Profile of trauma mortality and trauma care resources at rural emergency departments and urban trauma centres in Quebec: a population-based, retrospective cohort study

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

Telementoring and Teleproctoring in Trauma and Emergency Care

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