Carter Kyle William, Cassidy Kelsey, Bhimani Munsif
Schulich School of Medicine & Dentistry, The University of Western Ontario, London Ont., Canada.
Can J Rural Med. 2012 Summer;17(3):87-91.
We sought to determine the perceptions of physicians staffing rural emergency departments (EDs) in southwestern Ontario with respect to factors affecting patient care in the domains of physical resources, available support and education.
A confidential 30-item survey was distributed through ED chiefs to physicians working in rural EDs in southwestern Ontario. Using a 5-point Likert scale, physicians were asked to rate their perception of factors that affect patient care in their ED. Demographic and practice characteristics were collected to accurately represent the participating centres and physicians.
Twenty-seven of the 164 surveys distributed were completed (16% response rate). Responses were received from 13 (81.3%) of the 16 surveyed EDs. Most of the respondents (78%) held CCFP (Certificant of the College of Family Physicians) credentials, with no additional emergency medicine training. Crowding from inpatient boarding, and inadequate physician staffing or coverage in EDs were identified as having a negative impact on patient care. Information sharing within the hospital, access to emergent laboratory studies and physician access to medications in the ED were identified as having the greatest positive impact on patient care. Respondents viewed all questions in the domain of education as either positive or neutral.
Our survey results reveal that physicians practising emergency medicine in southwestern Ontario perceive crowding as the greatest barrier to providing patient care. Conversely, the survey identified that rural ED physicians perceive information sharing within the hospital, the availability of emergent laboratory studies and access to medications within the ED as having a strongly positive impact on patient care. Interestingly, our findings suggest that physicians in rural EDs view their access to education as adequate, as responses were either positive or neutral in regard to access to training and ability to maintain relevant skills.
我们试图确定安大略省西南部乡村急诊科医生对于影响患者护理的因素的看法，这些因素涉及物质资源、可获得的支持及教育等领域。
通过急诊科主任向在安大略省西南部乡村急诊科工作的医生发放一份包含30个项目的保密调查问卷。使用5分制李克特量表，要求医生对影响其所在急诊科患者护理的因素进行评分。收集人口统计学和执业特征信息，以准确反映参与调查的中心和医生情况。
发放的164份调查问卷中有27份完成（回复率为16%）。16个被调查的急诊科中有13个（81.3%）回复了问卷。大多数受访者（78%）拥有家庭医生学院认证资格（CCFP），未接受额外的急诊医学培训。住院患者滞留导致的拥挤以及急诊科医生人员配备不足或覆盖范围不够被认为对患者护理有负面影响。医院内部的信息共享、紧急实验室检查的可及性以及急诊科医生获取药物的便利性被认为对患者护理有最大的积极影响。受访者认为教育领域的所有问题要么是积极的，要么是中性的。
我们的调查结果显示，在安大略省西南部从事急诊医学的医生认为拥挤是提供患者护理的最大障碍。相反，调查发现乡村急诊科医生认为医院内部的信息共享、紧急实验室检查的可及性以及急诊科内获取药物的便利性对患者护理有强烈的积极影响。有趣的是，我们的研究结果表明，乡村急诊科医生认为他们接受教育的机会是充足的，因为在培训机会和维持相关技能的能力方面的回复要么是积极的，要么是中性的。
