Adams Ryan D F, Cole Elaine, Brundage Susan I, Morrison Zoe, Jansen Jan O
Queen Mary University of London, London, UK.
Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK.
Injury. 2018 Jun;49(6):1070-1078. doi: 10.1016/j.injury.2018.03.025. Epub 2018 Mar 22.
An understanding of stakeholders' views is key to the successful development and operation of a rural trauma system. Scotland, which has large remote and rural areas, is currently implementing a national trauma system. The aim of this study was to identify key barriers and enablers to the development of an effective trauma system from the perspective of rural healthcare professionals.
This is a qualitative study, which was conducted in rural general hospitals (RGH) in Scotland, from April to June 2017. We used an opportunistic sampling strategy to include hospital providers of rural trauma care across the region. Semi-structured interviews were conducted, recorded, and transcribed. Thematic analysis was used to identify and group participant perspectives on key barriers and enablers to the development of the new trauma system.
We conducted 15 interviews with 18 participants in six RGHs. Study participants described barriers and enablers across three themes: 1) quality of care, 2) interfaces within the system and 3) interfaces with the wider healthcare system. For quality of care, enablers included confidence in basic trauma management, whilst a perceived lack of change from current management was seen as a barrier. The theme of interfaces within the system identified good interaction with other services and a single point of contact for referral as enablers. Perceived barriers included challenges in referring to tertiary care. The final theme of interfaces with the wider healthcare system included an improved transport system, increased audit resource and coordinated clinical training as enablers. Perceived barriers included a rural staffing crisis and problematic patient transfer to further care.
This study provides insight into rural professionals' perceptions regarding the implementation of a trauma system in rural Scotland. Barriers included practical issues, such as retrieval, transfer and referral processes. Importantly, there is a degree of uncertainty, discontent and disengagement towards trauma system development, and concerns regarding staffing levels and governance. These issues are unlikely to be unique to Scotland and warrant further study to inform service planning and the effective delivery of rural trauma systems.
了解利益相关者的观点是农村创伤系统成功开发与运营的关键。苏格兰有大片偏远农村地区，目前正在实施全国性创伤系统。本研究旨在从农村医疗专业人员的角度确定有效创伤系统发展的关键障碍和推动因素。
这是一项定性研究，于2017年4月至6月在苏格兰的农村综合医院（RGH）进行。我们采用机会抽样策略，纳入了该地区农村创伤护理的医院提供者。进行了半结构化访谈，录音并转录。采用主题分析法来识别和归类参与者对新创伤系统发展的关键障碍和推动因素的看法。
我们在六个农村综合医院对18名参与者进行了15次访谈。研究参与者描述了三个主题下的障碍和推动因素：1）护理质量，2）系统内部接口，3）与更广泛医疗系统的接口。对于护理质量，推动因素包括对基本创伤管理的信心，而认为当前管理缺乏变化则被视为障碍。系统内部接口主题确定与其他服务的良好互动和单一转诊联系点为推动因素。感知到的障碍包括转诊到三级护理的挑战。与更广泛医疗系统接口的最后一个主题包括改善的运输系统、增加的审计资源和协调的临床培训为推动因素。感知到的障碍包括农村人员配置危机和患者转诊到进一步护理的问题。
本研究深入了解了农村专业人员对苏格兰农村创伤系统实施的看法。障碍包括实际问题，如检索、转移和转诊过程。重要的是，对创伤系统发展存在一定程度的不确定性、不满和不参与，以及对人员配备水平和治理的担忧。这些问题不太可能是苏格兰独有的，值得进一步研究以为服务规划和农村创伤系统的有效提供提供信息。
