Emergency trauma care in rural and remote settings: Challenges and patient outcomes

Morgan, Janita M.; Calleja, Pauline

doi:10.1016/j.ienj.2020.100880

Cited by 29 publications

(31 citation statements)

References 81 publications

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“…These differences led to extreme coping strategies such as self-cannulation or treatment discontinuation. The consequences of being unable to gain PIVC in these settings include facility transfer [56], or to escalation to Intraosseous access [57]. Further, if US equipment was available, it was likely staff were not trained in its use due to education deficits and/or staff turnover.…”

Section: Discussionmentioning

confidence: 99%

Peripheral intravenous catheter insertion and use of ultrasound in patients with difficult intravenous access: Australian patient and practitioner perspectives to inform future implementation strategies

Schults

Calleja

Slaughter³

et al. 2022

PLoS ONE

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Objective To understand healthcare worker and patient experience with peripheral intravenous catheter (PIVC) insertion in patients with difficult intravenous access (DIVA) including the use of ultrasound (US). Methods Descriptive study using 1-on-1 semi-structured interviews conducted between August 2020 and January 2021. Purposeful sampling was used to recruit healthcare practitioners (HCPs) and patients with DIVA who had PIVC experience. Data were analysed using inductive thematic analysis. Interview data were than mapped to the implementation theory Behaviour Change Wheel to inform implementation strategies. Results In total 78 interviews (13 patients; 65 HCPs) were completed with respondents from metropolitan (60%), regional (25%) and rural/remote (15%) settings across Australia. Thematic analysis revealed 4 major themes: i) Harmful patient experiences persist, with patient insights not leveraged to effect change; ii) ‘Escalation’ is just a word on the front lines; iii) Heightened risk of insertion failure without resources and training; and iv) Paving the way forward–‘measures need to be in place to prevent failed insertion attempts. Themes were mapped to the behaviour change wheel and implementation strategies developed, these included: staff education, e-health record for DIVA identification, DIVA standard of care and DIVA guidelines to support escalation and ultrasound use. Conclusion(s) DIVA patients continue to have poor healthcare experiences with PIVC insertion. There is poor standardisation of DIVA assessment, escalation, US use and clinician education across hospitals. Quality, safety, and education improvement opportunities exist to improve the patient with DIVA experience and prevent traumatic insertions. We identified a number of implementation strategies to support future ultrasound and DIVA pathway implementation.

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Section: Discussionmentioning

confidence: 99%

Peripheral intravenous catheter insertion and use of ultrasound in patients with difficult intravenous access: Australian patient and practitioner perspectives to inform future implementation strategies

Schults

Calleja

Slaughter³

et al. 2022

PLoS ONE

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“…is unclear why there is an increased incidence in our region. Proposed reasons for the increased incidence in a more rural state like South Dakota include but are not limited to: rural areas are more likely to have resource scarcity and may be less able to diagnose and treat disease efficiently, inflated cases from patients traveling large distances for specific care at our center, and influence of rural infrastructure such as water quality [14][15][16][17][18][19]. More frequent surgical treatment of systemic diseases like cancer and increased rates of surgical procedures could be reasons for a national increase in rates of hepatic abscesses; however, this would not fully explain this study's deviation from other studies [2,4,6,7,14].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, patients in rural areas could be delaying care for conditions like cholecystitis because of a lack of convenient access to healthcare facilities. Individuals in these communities may not have the ability to travel to a larger medical center to have a procedure done and increase their risk for liver abscesses from ascending cholangitis due to delayed care [16][17][18]. Interestingly, Streptococcus intermedius was the most common pathogen isolated from microbiologic studies.…”

Section: Table 3: Gross and Per Capita Incidence Of Hepatic Abscess And Domestic Wellsmentioning

confidence: 99%

Increased Incidence of Pyogenic Liver Abscess in a Midwest System With Emphasis on Rural Impact

Grassel¹,

Yim²,

Shriver³

et al. 2022

Cureus

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Objective: To assess if hepatic abscess incidence in a Midwest cohort was higher in rural areas compared to metropolitan areas in relation to water infrastructure.Materials and methods: All cases of hepatic abscesses from Jan 1, 2016 through Dec 31, 2019 at Avera McKennan Hospital in Sioux Falls, South Dakota (SD), were retrospectively collected. Chart review was completed for each case for risk factor analysis. Microbiology cultures and patient demographic data were collected including age, gender, hometown, and ethnicity. Risk factors assessed included a history of abdominal surgery, gallbladder disease, sepsis, diverticulitis, cancer, and diabetes. The incidence of hepatic abscesses was calculated using the Poisson rate test and confidence interval equation. Averages of each risk factor were calculated. Finally, hometown was utilized to create a heatmap of disease burden and compared to the density of private wells.Results: Our data yielded 116 confirmed adult hepatic abscesses between 2016 and 2019. The corrected incidence per 100,000 hospitalized patients per year is 95.66. The Poisson exact probability P-value was <0.01. Rural areas had a higher per capita incidence of abscesses and higher density of private wells.Conclusions: The incidence of hepatic abscesses is higher than national averages in this single-center study of Avera McKennan Hospital. Demographics, especially geographic location, play an important role in abscess rates. Rural location may be affecting the incidence of hepatic abscesses, explaining the much higher than expected incidence in this study. Infrastructure could be a contributing factor as much of the rural area is reliant on untreated groundwater.

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“…Such gaps in access disproportionately affect racial and ethnic minorities, who often live in rural, underserved areas [1]. Trauma, especially severe injuries requiring specialized care and/or surgical intervention, amplifies these disparities [2,3]. These rural patients often live geographically far from care, as described by a 2018 analysis of national hospital emergency general surgery capabilities by Khubchandani et al [1].…”

Section: Introductionmentioning

confidence: 99%

“…These rural patients often live geographically far from care, as described by a 2018 analysis of national hospital emergency general surgery capabilities by Khubchandani et al [1]. Once involved in a trauma, rural patients facing long travel times to hospitals and often receiving care outside of specialized trauma centers [4] are more likely to succumb to their injuries compared to patients who do not live in rural areas [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“Making It Work”: A Preliminary Mixed Methods Study of Rural Trauma Care Access and Resources in New Mexico

Carroll¹,

Garcia²,

Cassells³

et al. 2020

Cureus

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Introduction Patients in the rural western United States face challenges accessing trauma and surgical services and are more likely to succumb to their injuries. New Mexico, a rural and medically underresourced state, is a salient space to study these disparities. We examine how travel distance from trauma centers impacts injured patient outcomes and describe care delivery obstacles. Materials and Methods We conducted an explanatory mixed methods study by creating geospatial maps of New Mexico's trauma data, incorporating linear regression analyses on patient outcomes as a function of estimated travel distance from trauma centers. We also conducted qualitative semi-structured interviews with trauma providers to illuminate and provide context for the geospatial findings utilizing a systematic, collaborative, iterative transcript analysis process. We constructed a conceptual framework describing rural trauma care delivery obstacles. Results Geospatial analyses revealed that most New Mexicans face long travel times to trauma centers. Comparing regression analyses using different data sources suggests that solely hospital-derived data may undercount rural trauma deaths. Interviews with 10 providers suggest that elements that may contribute to these findings include on-the-ground resource-based challenges and those related to broader healthcare systemsbased issues. Our conceptual framework denotes how these elements collectively may impact rural trauma outcomes and proposes potential solutions. Conclusions In addressing rural patients' needs, healthcare policy decision-makers should ensure that their datasets are comprehensive and inclusive. They must also take into account the particular challenges of underserved rural patients and providers who care for them by eliciting their perspectives, as presented in our conceptual framework.

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Emergency trauma care in rural and remote settings: Challenges and patient outcomes

Cited by 29 publications

References 81 publications

Peripheral intravenous catheter insertion and use of ultrasound in patients with difficult intravenous access: Australian patient and practitioner perspectives to inform future implementation strategies

Peripheral intravenous catheter insertion and use of ultrasound in patients with difficult intravenous access: Australian patient and practitioner perspectives to inform future implementation strategies

Increased Incidence of Pyogenic Liver Abscess in a Midwest System With Emphasis on Rural Impact

“Making It Work”: A Preliminary Mixed Methods Study of Rural Trauma Care Access and Resources in New Mexico

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