Jiang Henry Y, MacLean Alyssa, Yoon Jenny, Hughes Susan, Kim Michael J, Anantha Ram V, Widder Sandy L
From the Department of Surgery, University of Alberta Hospital, University of Alberta, Alta. (Jiang, MacLean, Yoon, Hughes, Kim, Anantha, Widder); and Alberta Trauma Services Edmonton Zone, Alberta Health Services, Edmonton, Alta. (Hughes, Kim, Anantha, Widder).
Can J Surg. 2020 Aug 28;63(5):E383-E390. doi: 10.1503/cjs.007119.
The care of rural trauma patients in northern Alberta can be extremely challenging because of the vast geographic area, the limited access to health care facilities and the lack of adequate resources to manage severe injuries. Identifying gaps in equipment and personnel in rural centres can provide opportunities for improving the care of injured patients in these environments. We conducted a survey based on Canadian Accreditation Council quality indicators to evaluate trauma infrastructure and human resources in rural centres across northern Alberta.
A standardized survey was developed to assess the availability of trauma-specific equipment and personnel across the prehospital and emergency department (ED) settings. The survey was distributed to 50 peripheral hospitals biannually from January 2017 to September 2018. Two-tailed paired t tests were used to evaluate changes in survey responses; a p value of less than 0.05 was considered statistically significant.
The survey response rate was 100%. By the end of the study period, there were significant improvements in the number of providers (p = 0.04), nurses (p = 0.01) and dedicated trauma resuscitation bays (p = 0.04) in the ED for managing injured patients. There were also significant increases in the availability of equipment, including advanced airway management tools (p = 0.02), rapid infusion devices (p = 0.02) and warmers (p = 0.04). Access to x-ray equipment (p = 0.03) and computed tomography (CT) scanners (p = 0.04) as well as equipment to support telehealth and teleconferencing (p = 0.04) increased during the study period. Access to, and supply of, blood products also increased significantly (p = 0.02) during the study period.
Our study demonstrates that the trauma resources of rural health care centres may be evaluated in a standardized fashion centres, and the results point to opportunities to remedy gaps in equipment and personnel. Our methods may be applied to any trauma network that serves geographically large areas with a sparse distribution of health care facilities, to provide critical information for the optimization of resources in rural trauma.
由于地理区域广阔、获得医疗保健设施的机会有限以及缺乏管理重伤的充足资源，阿尔伯塔省北部农村创伤患者的护理极具挑战性。识别农村医疗中心在设备和人员方面的差距可为改善这些环境中受伤患者的护理提供机会。我们基于加拿大认证委员会质量指标进行了一项调查，以评估阿尔伯塔省北部农村医疗中心的创伤基础设施和人力资源。
制定了一项标准化调查，以评估院前和急诊科（ED）环境中特定创伤设备和人员的可用性。该调查在2017年1月至2018年9月期间每半年分发给50家周边医院。采用双尾配对t检验来评估调查回复的变化；p值小于0.05被认为具有统计学意义。
调查回复率为100%。到研究期结束时，急诊科用于管理受伤患者的医护人员数量（p = 0.04）、护士数量（p = 0.01）和专用创伤复苏区数量（p = 0.04）有显著改善。设备的可用性也有显著增加，包括高级气道管理工具（p = 0.02）、快速输液装置（p = 0.02）和保暖设备（p = 0.04）。在研究期间，获得x光设备（p = 0.03）、计算机断层扫描（CT）扫描仪（p = 0.04）以及支持远程医疗和电话会议的设备（p = 0.04）的机会增加。在研究期间，血液制品的获取和供应也显著增加（p = 0.02）。
我们的研究表明，农村医疗中心的创伤资源可以通过标准化方式进行评估，结果指出了弥补设备和人员差距的机会。我们的方法可应用于任何为医疗保健设施分布稀疏的广大地理区域服务的创伤网络，为优化农村创伤资源提供关键信息。
