scholarly journals P012: Québec emergency physicians propose priority solutions to improve rural emergency care

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S81-S82
Author(s):  
J. Audet ◽  
L. Lapointe ◽  
M. Renaud ◽  
C. Turgeon-Pelchat ◽  
B. Mathieu ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Rural Areas ◽  
Annual Conference ◽  
Staff Retention ◽  
Emergency Physicians ◽  
Three Solutions ◽  
Rural Regions ◽  
Priority Level ◽  
Targeted Ultrasound

Introduction: In the province of Québec, roughly 20% of the population lives in rural areas. Rural emergency departments (EDs) face different challenges than their urban counterparts. Yet, few studies have sought to understand these challenges. This study aims to survey Québec’s emergency physicians to: 1) identify problems specific to rural EDs, 2) find solutions for improving accessibility and quality of care offered in rural regions and, 3) rank solutions in order of priority. These results will allow data triangulation with other of our studies that seek to identify challenges faced by rural EDs and potential solutions. Methods: During the 2016 annual conference of the Québec Emergency Physicians’ Association, we asked physicians and residents (including those from urban EDs), to complete a survey about the challenges faced by rural EDs. The survey contained two sections. The first took the form of open-ended questions in which respondents could write three challenges about accessibility and quality of care in rural EDs (objective 1) and three solutions to address these challenges (objective 2). The second section listed 11 potential solutions identified in our previous study. The solutions were ranked based on their priority level on a five-point Likert scale that ranged from “not a priority” to “an absolute priority” (objective 3). We added the total number of points for each solution and produced a ranking list. Results: Ninety-one physicians out of the 417 at the conference completed the survey; 58% came from urban EDs and 42% from rural EDs. Open-ended questions suggest that access to specialists and interfacility transfers are the principal challenges faced by rural EDs. The top five solutions identified as the highest priorities were: 1) care protocols, 2) improvement of interfacility transfers, 3) training with simulators, 4) targeted ultrasound and, 5) implementation of staff retention and recruitment strategies. Conclusion: This study is relevant and useful as roughly a quarter of attendants at the conference spontaneously volunteered to help identify and prioritize solutions to foster the accessibility and quality of care in rural EDs. Furthermore, it represents a stepping stone for our recently-launched wide-scope study, Urgences Rurales 360, that aims to explore problems faced by every of the 28 rural EDs in Québec and the solutions that could be implemented to resolve them.

scholarly journals How to improve quality of care in overcrowded emergency departments? Development and evaluation of a virtual research environment. (Preprint)

2019 ◽  
Author(s):  
Charles-Henri Houze Cerfon ◽  
Christine Vaissié ◽  
Laurent Gout ◽  
Bruno Bastiani ◽  
Sandrine Charpentier ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Quality Of Care ◽  
Simulated Patients ◽  
Emergency Physicians ◽  
Research Environment ◽  
Significant Difference ◽  
Ed Overcrowding ◽  
Virtual Research Environment

BACKGROUND Despite wide literature on ED overcrowding, scientific knowledge on emergency physicians’ cognitive processes coping with overcrowding is limited. OBJECTIVE We sought to develop and evaluate a virtual research environment that will allow us to study the effect of physicians’ strategies and behaviours on quality of care in the context of emergency department overcrowding. METHODS A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in Emergency Medicine combining virtual reality and simulated patients has been designed and developed. Then, twelve emergency physicians took part in simulation scenarios and had to manage thirteen patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency and mastering. The realism was the resemblance perceived by the participants between virtual and real Emergency Department. The consistency of the scenario and the participants’ mastering of the environment was expected for 90% of the participants. RESULTS The virtual emergency department was considered realistic with no significant difference from the real world concerning facilities and resources except for the length of time of procedures that was perceived to be shorter. 100% of participants deemed that patient information, decision-making and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. CONCLUSIONS The new simulation tool, Virtual Research Environment in Emergency Medicine has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared to real EDs and thus offers another way to study human factors, quality of care and patient safety in the context of ED overcrowding.

Telepsychiatry Use in Rural Areas in the United States

2020 ◽  
Vol 13 (4) ◽  
pp. 1-13
Author(s):  
Alberto Coustasse ◽  
Morgan Ruley ◽  
Tonnie C. Mike ◽  
Briana M. Washington ◽  
Anna Robinson
Keyword(s):  
Mental Health ◽  
United States ◽  
Quality Of Care ◽  
Rural Areas ◽  
Care Delivery ◽  
Mental Healthcare ◽  
Healthcare Services ◽  
The United States ◽  
Access And Quality

Rural areas have experienced a higher than average shortage of healthcare professionals. Numerous challenges have limited access to mental health services. Some of these barriers have included transportation, number of providers, poverty, and lack of insurance. Recently, the utilization of telepsychiatry has increased in rural areas. The purpose of this review was to identify and coalesce the benefits of telepsychiatry for adults living in rural communities in the United States to determine if telepsychiatry has improved access and quality of care. The methodology for this study was a literature review that followed a systematic approach. References and sources were written in English and were taken from studies in the United States between 2004 and 2018 to keep this review current. Fifty-nine references were selected from five databases. It was found that several studies supported that telepsychiatry has improved access and quality of care available in rural environments. At the same time, telepsychiatry in mental healthcare has not been utilized as it should in rural adult populations due to lack of access, an overall shortage of providers, and poor distribution of psychiatrists. There are numerous benefits to implementing telepsychiatry in rural areas. While there are still barriers that prevent widespread utilization, telepsychiatry can improve mental health outcomes by linking rural patients to high-quality mental healthcare services that follow evidence-based care and best practices. Telepsychiatry utilization in rural areas in the United States has demonstrated to have a significant ability to transform mental health care delivery and clinician productivity. As technology continues to advance access, telepsychiatry will also advance, making access more readily available.

scholarly journals Understanding how distance to facility and quality of care affect maternal health service utilization in Kenya and Haiti: A comparative geographic information system study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xing Gao ◽  
David Wayne Kelley
Keyword(s):  
Quality Of Care ◽  
Maternal Health ◽  
Health Service ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Geographic Information ◽  
Maternal Health Service ◽  
Rural Regions ◽  
Urban Regions

In 2000, the United Nations established eight Millennium Development Goals (MDG) to combat worldwide poverty, disease, and lack of primary education. Goal number five aimed to reduce the maternal mortality ratio by three quarters and provide universal access to reproductive healthcare services by 2015. While there has been some progress, MDG 5 fell far short of target goals, highlighting the necessity of further improvement in global maternal health. Using Geographic Information Systems (GIS), this study aims to understand how distance to facility and quality of care, which are components of access, affect maternal service utilization in two of the world’s poorest countries, Haiti and Kenya. Furthermore, this study examines how this relationship may change or hold between urban and rural regions. Data from the United States Agency for International Development Demographic and Health Survey and Service Provision Assessment were linked spatially in a GIS model, drawing comparisons among distance to facility, quality of care, and maternal health service utilization. Results show that in both rural and urban regions, access to maternal health service and maternal health service utilization share a similar spatial pattern. In urban regions, pockets of maternal health disparities exist despite close distance to facility and standard quality of care. In rural regions, there are areas with long distances to facilities and low quality of care, resulting in poor maternal service usage. This study highlights the usefulness of GIS as a tool to evaluate disparities in maternal healthcare provision and usage.

Quality of care of VLBW neonates: relationship between unit volume and outcome is different between metropolitan and rural regions

2008 ◽  
Vol 97 (10) ◽  
pp. 1470-1474 ◽  
Author(s):  
F Jochum ◽  
B Schmidt ◽  
K Schunk ◽  
V Hesse ◽  
B Distler ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Unit Volume ◽  
Rural Regions

scholarly journals Barriers to Quality of Care for Cancer Patients in Rural Areas: A Study from the Faroe Islands

2020 ◽  
Vol Volume 13 ◽  
pp. 63-70
Author(s):  
Birna Mohr Joensen ◽  
Sonja Nielsen ◽  
Ása Róin
Keyword(s):  
Quality Of Care ◽  
Cancer Patients ◽  
Rural Areas ◽  
Faroe Islands

scholarly journals Development and Evaluation of a Virtual Research Environment to Improve Quality of Care in Overcrowded Emergency Departments: Observational Study

10.2196/13993 ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. e13993
Author(s):  
Charles-Henri Houze-Cerfon ◽  
Christine Vaissié ◽  
Laurent Gout ◽  
Bruno Bastiani ◽  
Sandrine Charpentier ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Quality Of Care ◽  
Observational Study ◽  
Emergency Physicians ◽  
Research Environment ◽  
Wide Range ◽  
Significant Difference ◽  
Ed Overcrowding ◽  
Virtual Research Environment

Background Despite a wide range of literature on emergency department (ED) overcrowding, scientific knowledge on emergency physicians’ cognitive processes coping with overcrowding is limited. Objective This study aimed to develop and evaluate a virtual research environment that will allow us to study the effect of physicians’ strategies and behaviors on quality of care in the context of ED overcrowding. Methods A simulation-based observational study was conducted over two stages: the development of a simulation model and its evaluation. A research environment in emergency medicine combining virtual reality and simulated patients was designed and developed. Afterwards, 12 emergency physicians took part in simulation scenarios and had to manage 13 patients during a 2-hour period. The study outcome was the authenticity of the environment through realism, consistency, and mastering. The realism was the resemblance perceived by the participants between virtual and real ED. The consistency of the scenario and the participants’ mastering of the environment was expected for 90% (12/13) of the participants. Results The virtual ED was considered realistic with no significant difference from the real world with respect to facilities and resources, except for the length of time of procedures that was perceived to be shorter. A total of 100% (13/13) of participants deemed that patient information, decision making, and managing patient flow were similar to real clinical practice. The virtual environment was well-mastered by all participants over the course of the scenarios. Conclusions The new simulation tool, Virtual Research Environment in Emergency Medicine, has been successfully designed and developed. It has been assessed as perfectly authentic by emergency physicians compared with real EDs and thus offers another way to study human factors, quality of care, and patient safety in the context of ED overcrowding.

scholarly journals THE INFLUENCE OF STAFF RETENTION ON NURSING HOME QUALITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S701-S701 ◽  
Author(s):  
Nicholas Castle ◽  
Kathryn Hyer ◽  
John A Harris
Keyword(s):  
Nursing Home ◽  
Quality Of Care ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Staff Retention ◽  
Nursing Home Administrators ◽  
Logistic Regression Models ◽  
Nursing Home Quality ◽  
One Year

Abstract The association of retention of Nurse Aides (NAs) with nursing home quality of care is examined. Retention is defined as staff continuously employed in the same facility for a defined period of time. Deficiency citations were used as quality indicators. Data used came from a survey of nursing home administrators, the Certification and Survey Provider Enhanced Reporting (CASPER) data, and the Area Resource File. All of the data was from 2015, and included 3,550 facilities. Analyses included negative binomial regression and multivariate logistic regression models (using GEE). The analytic modeling included staffing variables (turnover, agency use, staffing levels), facility factors (size, ownership, occupancy rate), and market characteristics (competition, Medicaid rates). The average number of deficiency citations was significantly lower (p<.01) in facilities with the higher levels of NAs consistently employed for one year or more. The same was found for facilities with the higher levels of NAs consistently employed for two years or more. While the average number of deficiency citations, the quality of care grouping of deficiency citations, and J, K, L deficiency citations were all significantly lower (p<.01) in facilities with the higher levels of NAs consistently employed for three years or more. Staff retention has been promoted as potentially influential based on little empirical evidence. The findings provide some justification for the importance of NA retention.

Moral distress in nursing

2012 ◽  
Vol 20 (3) ◽  
pp. 312-324 ◽  
Author(s):  
Adam S Burston ◽  
Anthony G Tuckett
Keyword(s):  
Quality Of Care ◽  
Physical Health ◽  
Moral Distress ◽  
Nursing Workforce ◽  
Staff Retention ◽  
Workplace Satisfaction ◽  
Core Set ◽  
Organizational Levels

Moral distress has been widely reviewed across many care contexts and among a range of disciplines. Interest in this area has produced a plethora of studies, commentary and critique. An overview of the literature around moral distress reveals a commonality about factors contributing to moral distress, the attendant outcomes of this distress and a core set of interventions recommended to address these. Interventions at both personal and organizational levels have been proposed. The relevance of this overview resides in the implications moral distress has on the nurse and the nursing workforce: particularly in regard to quality of care, diminished workplace satisfaction and physical health of staff and increased problems with staff retention.

Quality of care of VLBW-neonates: relationship between unit volume and outcome is different between metropolitan and rural regions

2009 ◽  
Vol 98 (4) ◽  
pp. 610-612
Author(s):  
F Jochum ◽  
B Schmidt ◽  
K Schunk ◽  
V Hesse ◽  
B Distler ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Unit Volume ◽  
Rural Regions

scholarly journals Person-Centred Care Transformation in a Nursing Home for Residents with Dementia

2021 ◽  
pp. 1-9
Author(s):  
Peiyan Ho ◽  
Rachel Chin Yee Cheong ◽  
Siew Pei Ong ◽  
Carol Fusek ◽  
Shiou Liang Wee ◽  
...  
Keyword(s):  
Nursing Home ◽  
Quality Of Care ◽  
Nursing Homes ◽  
Quality Care ◽  
Well Being ◽  
Care Quality ◽  
Care Recipient ◽  
Staff Retention ◽  
Term Care

<b><i>Background:</i></b> Conventional nursing homes in Singapore adopt an institutional and medical model of care with a focus on safety and risk management. As such, less regard is placed on upholding the dignity and autonomy of the resident, which compromises quality of care and the well-being of the resident. Today, person-centred care (PCC) has become synonymous with high-quality care that sustains the well-being and personhood of the care recipient. <b><i>Objectives:</i></b> To describe the model of PCC adopted by a nursing home, Apex Harmony Lodge (AHL), with a logic model and evaluate outcomes on residents’ well-being, care quality, and staff attrition by comparing pre-PCC initiation (2015) to post-implementation (2016). <b><i>Methods:</i></b> Male residents in a 30-bed assisted living facility for persons with dementia in AHL were assessed using Dementia Care Mapping. Residents’ well-being and staff attrition were measured before and after PCC implementation. <b><i>Results:</i></b> There were statistically significant improvements in resident well-being (Δ = 0.44, <i>p</i> = 0.029), Positive Engagement Potential (Δ = 0.17, <i>p</i> = 0.002), and Occupational Diversity (Δ = 0.12, <i>p</i> = 0.014) in 2016. Withdrawal and Passive Engagement in the residents were reduced significantly as were Care Detractors. There was also a 55% reduction in staff attrition rates post-PCC. <b><i>Conclusions:</i></b> Post-PCC implementation, the outcomes indicate a superior quality of care, enhanced resident well-being, and better staff retention. The AHL PCC model could serve as a roadmap for other nursing homes aspiring to raise the quality of care and influence long-term care standards and regulations for policy makers and legislators.

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