Efficacy of educational interventions on improving medical emergency readiness of rural healthcare providers: a scoping review

BACKGROUND

Medical emergencies are the leading cause of high mortality and morbidity rates in rural areas of higher and lower-income countries than in urban areas. Medical emergency readiness is healthcare providers' knowledge, skills, and confidence to meet patients' emergency needs. Rural healthcare professionals' medical emergency readiness is imperative to prevent or reduce casualties due to medical emergencies. Evidence shows that rural healthcare providers' emergency readiness needs enhancement. Education and training are the effective ways to improve them. However, there has yet to be a scoping review to understand the efficacy of educational intervention regarding rural healthcare providers' medical emergency readiness.

OBJECTIVES

This scoping review aimed to identify and understand the effectiveness of educational interventions in improving rural healthcare providers' medical emergency readiness globally.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews were used to select the papers for this scoping review. This scoping review was conducted using MEDLINE, CINHAL, SCOPUS, PUBMED and OVID databases. The Population, Intervention, Comparison and Outcome [PICO] strategies were used to select the papers from the database. The selected papers were limited to English, peer-reviewed journals and published from 2013 to 2023. A total of 536 studies were retrieved, and ten studies that met the selection criteria were included in the review. Three reviewers appraised the selected papers individually using the Joanna Briggs Institute [JBI] critical appraisal tool. A descriptive method was used to analyse the data.

RESULTS

From the identified 536 papers, the ten papers which met the PICO strategies were selected for the scoping review. Results show that rural healthcare providers' emergency readiness remains the same globally. All interventions were effective in enhancing rural health care providers' medical emergency readiness, though the interventions were implemented at various durations of time and in different foci of medical emergencies. Results showed that the low-fidelity simulated manikins were the most cost-effective intervention to train rural healthcare professionals globally.

CONCLUSION

The review concluded that rural healthcare providers' medical emergency readiness improved after the interventions. However, the limitations associated with the studies caution readers to read the results sensibly. Moreover, future research should focus on understanding the interventions' behavioural outcomes, especially among rural healthcare providers in low to middle-income countries.

Effect of trauma quality improvement initiatives on outcomes and costs at community hospitals: A scoping review

BACKGROUND

Due to complex geography and resource constraints, trauma patients are often initially transported to community or rural facilities rather than a larger Level I or II trauma center. The objective of this scoping review was to synthesize evidence on interventions that improved the quality of trauma care and/or reduced healthcare costs at non-Level I or II facilities.

METHODS

A scoping review was performed to identify studies implementing a Quality Improvement (QI) initiative at a non-major trauma center (i.e., non-Level I or II trauma center [or equivalent]). We searched 3 electronic databases (MEDLINE, Embase, CINAHL) and the grey literature (relevant networks, organizations/associations). Methodological quality was evaluated using NIH and JBI study quality assessment tools. Studies were included if they evaluated the effect of implementing a trauma care QI initiative on one or more of the following: 1) trauma outcomes (mortality, morbidity); 2) system outcomes (e.g., length of stay [LOS], transfer times, provider factors); 3) provider knowledge or perception; or 4) healthcare costs. Pediatric trauma, pre-hospital and tele-trauma specific studies were excluded.

RESULTS

Of 1046 data sources screened, 36 were included for full review (29 journal articles, 7 abstracts/posters without full text). Educational initiatives including the Rural Trauma Team Development Course and the Advanced Trauma Life Support course were the most common QI interventions investigated. Study outcomes included process metrics such as transfer time to tertiary care and hospital LOS, along with measures of provider perception and knowledge. Improvement in mortality was reported in a single study evaluating the impact of establishing a dedicated trauma service at a community hospital.

CONCLUSIONS

Our review captured a broad spectrum of trauma QI projects implemented at non-major trauma centers. Educational interventions did result in process outcome improvements and high rates of self-reported improvements in trauma care. Given the heterogeneous capabilities of community and rural hospitals, there is no panacea for trauma QI at these facilities. Future research should focus on patient outcomes like mortality and morbidity, and locally relevant initiatives.

Consensus-based recommendations for strengthening emergency care at primary health care level: a Delphi study

BACKGROUND

Emergency care at a primary health care (PHC) level must be strengthened to reduce overall mortality and morbidity in any country. Developing recommendations for improvement in this area should take into consideration the context and nuances of the current emergency care system and primary health care context. Contribution to policy from the experts in the cross-cutting fields of PHC and emergency care is lacking.

OBJECTIVES

This study aims to evaluate the strengths and weaknesses of emergency care in primary health settings and develop consensus-based recommendations for the strengthening of emergency care at this level.

METHODS

Using a modified Delphi technique, data were collected from various data sources to evaluate the strengths and weaknesses of emergency care at PHC level, from which recommendation statements were developed. These recommendations were proposed to a panel of experts using a Delphi survey to build consensus on 14 recommendations to strengthen emergency care at PHC level.

RESULTS

Ten experts were recruited to participate (n = 10) with a response rate of 90% in round II and 80% in round III of Delphi. Recommendations broadly addressed the areas of education and training in emergency care, the role and placement of various actors, leadership in emergency care and the development of a national plan for emergency care. Consensus was reached in round II for 97.61% of the statements and after modification based on open-ended comments, 98.21% consensus was reached in round III.

CONCLUSION

Strengthening emergency care at primary and subsequent levels of health care requires a coordinated effort and mandate from authority in order to effect real change.

Trauma Team High-Fidelity Simulation Training in a Rural Level III Trauma Center: An Interprofessional Experience

BACKGROUND

Emergency department trauma resuscitation requires teamwork and high-stakes clinical decision-making. Rural trauma centers with low trauma activation volumes must ensure that resuscitations are efficient and safe.

OBJECTIVE

The purpose of this article is to describe the implementation of high-fidelity, interprofessional simulation training to foster trauma teamwork and role identification for trauma team members responding to trauma activations in the emergency department.

METHODS

High-fidelity, interprofessional simulation training was developed for members of a rural Level III trauma center. Subject matter experts created trauma scenarios. An embedded participant led the simulations using a guidebook that outlined the scenario and learner objectives. The simulations were implemented from May 2021 through September 2021.

RESULTS

Postsimulation survey results identified that participants found training with other professions valuable and that knowledge was gained.

CONCLUSION

Interprofessional simulations enhance team communication and skills. Combining interprofessional education with high-fidelity simulation creates a learning environment that optimizes trauma team function.

An Educational Outreach Program: A Trauma System's 5-Year Experience

BACKGROUND

The American College of Surgeons Committee on Trauma requires Level I and II trauma centers to provide educational outreach to lower-level facilities. Although outreach is a required part of any trauma system, very little is published on the resources required for a successful program.

OBJECTIVE

The purpose of this article is to provide a comprehensive roadmap of the required components to achieve a successful trauma outreach program.

METHODS

This project describes the development and implementation of an educational outreach program from January 2016 to December 2020 that has grown from 27 facilities within one western state to 49 facilities across 14 different states. Program components measured include the number and attendance of trauma courses offered, including the Trauma Nursing Core Course (TNCC), Advanced Trauma Life Support (ATLS), Rural Trauma Team Development Course (RTTDC), the number of trauma meetings and webinars provided, total trauma center designation and reviews, total states reached, and total trauma center collaborations.

RESULTS

From 2016 to 2020, the program more than doubled the number of TNCC and ATLS courses, maintained the number of RTTDC offered, and observed attendance rate increases of 33% and 11% for TNCC and ATLS courses, respectively. Outreach leadership attended 44 trauma meetings and educational webinars using virtual platform technology, nearly doubling the trauma center outreach with expansion across 14 states resulting in important changes in practice.

CONCLUSION

With administrative support, effective leadership, and technology, outreach programs can serve as important resources for statewide trauma systems.

How might access to postgraduate medical education in regional and rural locations be best improved? A scoping review

Rural medical education is known as one of the most effective strategies in improving rural recruitment and retention. The aim was to identify modes of delivery to improve access to rural postgraduate medical education. Arksey and O'Malley's methodological framework was used for conducting scoping reviews. CINAHL, Google Scholar, ERIC, PsycINFO, Medline and PubMed were searched to identify peer-reviewed English-language literature published between 2000 and 2019 focusing on postgraduate rural and regional medical education. A total of 102 articles were identified, with 51 included in the final analysis after applying inclusion and exclusion criteria. Outcome measures included: article type; research methodology; date of publication; country of origin; and study population. Through iterative reading, common themes were identified. A typology of 6 content themes emerged as follows: rural curriculum; procedural skills; rurally based learning; service delivery; workforce; and distance learning. The majority of articles focused on rural curriculum, and rurally based learning, with half originating from Australia or New Zealand. Although results strongly emphasised context and curriculum in rural environments, lack of specific and pragmatic approaches was noted. Surprisingly, few articles focused on rural distance learning utilising information and communication technology. Pathways to improve rural education access include recognition of the unique rural context in curriculums; development of rural educational faculty; and creation of opportunities for rural specialist training. Emphasis should be given for education provided through rural centres rather than urban facilities. Use of information technology could be increased, for example in remote trainee supervision programs.