Public Health Considerations in Knowledge Translation in the Emergency Department

Abstract

Effective preventive and screening interventions have not been widely adopted in emergency departments (EDs). Barriers to knowledge translation of these initiatives include lack of knowledge of current evidence, perceived lack of efficacy, and resource availability. To address this challenge, the Academic Emergency Medicine 2007 Consensus Conference, ''Knowledge Translation in Emergency Medicine: Establishing a Research Agenda and Guide Map for Evidence Uptake,'' convened a public health focus group. The question this group addressed was ''What are the unique contextual elements that need to be addressed to bring proven preventive and other public health initiatives into the ED setting?'' Public health experts communicated via the Internet beforehand and at a breakout session during the conference to reach consensus on this topic, using published evidence and expert opinion. Recommendations include 1) to integrate proven public health interventions into the emergency medicine core curriculum, 2) to configure clinical information systems to facilitate public health interventions, and 3) to use ancillary ED personnel to enhance delivery of public health interventions and to obtain successful funding for these initiatives. Because additional research in this area is needed, a research agenda for this important topic was also developed. The ED provides medical care to a unique population, many with increased needs for preventive care. Because these individuals may have limited access to screening and preventive interventions, wider adoption of these initiatives may improve the health of this vulnerable population.

Public health in Australasian emergency departments: Attitudes, barriers and current practices

“…For many respondents, the question is not whether public health has a role in emergency medicine but how much of a role and how is this resourced. The barriers identified in our study to the implementation of public health initiatives in EDs support this and are consistent with previous studies, including available funding, time, resources and culture . With appropriate health system planning many of these barriers could be addressed in the short or medium term.…”

“…This opportunity of the teachable moment is being lost due to lack of resources and time; however, screening and simple interventions might be a way forward to highlight preventive health issues and initiate a patient response. A growing body of research into the efficacy of screening, brief interventions and referral to treatment (SBIRT) strategies in EDs exists, each with varying levels of success .…”

“…Emergency medicine and public health interact over the following domains: surveillance of illness and injuries; delivering preventive interventions; monitoring access to health services by the general population; and advocacy and policy development in public health areas . However, traditionally emergency medicine has focused on managing acutely ill and injured patients .…”

Feasibility and outcomes of screening for cardiovascular risk factors in the emergency department

“…The ED has a great potential to facilitate preventive health programmes . This is consistent with the policy of the Australasian College for Emergency Medicine that advocates an active role for EDs in strategies aimed at emphasising the prevention of illness and injury and the promotion of healthy lifestyles .…”

Hot Off the Press: Please Stop, Prescribing – Antibiotics for Viral Acute Respiratory Infections

“…Despite recognizing the need for antibiotic stewardship by EDs and emergency providers, this has not led to practice change . Providers in the ED and UCC setting are faced with numerous challenges that may limit change, including frequent interruptions, boarding and overcrowding, frequent patient handoffs, and the need to see high volumes of patients …”