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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Improving access to emergent spinal care through knowledge translation: An ethnographic study
BMC Health Services Research, Volume 14, No. 1, Article 169, Year 2014
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Description
Background: For patients and family members, access to timely specialty medical care for emergent spinal conditions is a significant stressor to an already serious condition. Timing to surgical care for emergent spinal conditions such as spinal trauma is an important predictor of outcome. However, few studies have explored ethnographically the views of surgeons and other key stakeholders on issues related to patient access and care for emergent spine conditions. The primary study objective was to determine the challenges to the provision of timely care as well as to identify areas of opportunities to enhance care delivery. Methods. An ethnographic study of key administrative and clinical care providers involved in the triage and care of patients referred through CritiCall Ontario was undertaken utilizing standard methods of qualitative inquiry. This comprised 21 interviews with people involved in varying capacities with the provision of emergent spinal care, as well as qualitative observations on an orthopaedic/neurosurgical ward, in operating theatres, and at CritiCall Ontario's call centre. Results: Several themes were identified and organized into categories that range from inter-professional collaboration through to issues of hospital-level resources and the role of relationships between hospitals and external organizations at the provincial level. Underlying many of these issues is the nature of the medically complex emergent spine patient and the scientific evidentiary base upon which best practice care is delivered. Through the implementation of knowledge translation strategies facilitated from this research, a reduction of patient transfers out of province was observed in the one-year period following program implementation. Conclusions: Our findings suggest that competing priorities at both the hospital and provincial level create challenges in the delivery of spinal care. Key stakeholders recognized spinal care as aligning with multiple priorities such as emergent/critical care, medical through surgical, acute through rehabilitative, disease-based (i.e. trauma, cancer), and wait times initiatives. However, despite newly implemented strategies, there continues to be increasing trends over time in the number of spinal CritiCall Ontario referrals. This reinforces the need for ongoing inter-professional efforts in care delivery that take into account the institutional contexts that may constrain individual or team efforts. © 2014 Webster et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Webster, Fiona
Canada, Toronto
University of Toronto
Fehlings, Michael George
Canada, Toronto
University of Toronto
Rice, Kathleen F.
Canada, Toronto
University of Toronto
Malempati, Harsha
Canada, Toronto
Sunnybrook Health Sciences Centre
Fawaz, Khaled
Egypt, Giza
Cairo University
Nicholls, Fred
Canada, Toronto
University of Toronto
Baldeo, Navindra
Canada, Toronto
Institute of Health Policy, Management and Evaluation
Reeves, Scott
United States, San Francisco
University of California, San Francisco
Singh, Anoushka
Canada, Toronto
University Health Network University of Toronto
Ahn, Henry
Canada, Toronto
University of Toronto
Ginsberg, Howard
Canada, Toronto
Saint Michael's Hospital University of Toronto
Yee, Albert J.
Canada, Toronto
University of Toronto
Statistics
Citations: 12
Authors: 12
Affiliations: 7
Identifiers
Doi:
10.1186/1472-6963-14-169
e-ISSN:
14726963
Research Areas
Cancer
Health System And Policy
Study Design
Ethnographic Study
Study Approach
Qualitative