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Open Access Research article

Improving access to emergent spinal care through knowledge translation: an ethnographic study

Fiona Webster1*, Michael G Fehlings2, Kathleen Rice3, Harsha Malempati4, Khaled Fawaz5, Fred Nicholls6, Navindra Baldeo7, Scott Reeves8, Anoushka Singh9, Henry Ahn10, Howard Ginsberg11 and Albert J Yee12

Author Affiliations

1 Department of Family & Community Medicine, University of Toronto, 500 University Ave, 5th floor, Toronto, Ontario M5G 1 V7, Canada

2 Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON. Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada

3 Department of Anthropology, University of Toronto, 19 Russell Street, Toronto, Ontario M5S 2S2, Canada

4 Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3 M5, Canada

5 Orthopaedic Surgery, Cairo University, Cairo, Egypt

6 Department of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada

7 Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, M5T 3 M6 Toronto, Ontario, Canada

8 Center for Innovation in Interprofessional Education, University of California, 530 Parnassus Avenue, Library, San Francisco, CA 94143, USA

9 Krembil Neurosciences Department, Toronto Western Hospital University Health Network, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada

10 Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada

11 Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON. St. Michael’s Hospital, 30 Bond St., 3 Bond Wing, Toronto, ON M5B 1 W8, Canada

12 Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 149 College Street, Toronto, Ontario M5T 1P5, Canada

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BMC Health Services Research 2014, 14:169  doi:10.1186/1472-6963-14-169

Published: 14 April 2014

Abstract

Background

For patients and family members, access to timely specialty medical care for emergent spinal conditions is a significant stressor to an already serious condition. Timing to surgical care for emergent spinal conditions such as spinal trauma is an important predictor of outcome. However, few studies have explored ethnographically the views of surgeons and other key stakeholders on issues related to patient access and care for emergent spine conditions. The primary study objective was to determine the challenges to the provision of timely care as well as to identify areas of opportunities to enhance care delivery.

Methods

An ethnographic study of key administrative and clinical care providers involved in the triage and care of patients referred through CritiCall Ontario was undertaken utilizing standard methods of qualitative inquiry. This comprised 21 interviews with people involved in varying capacities with the provision of emergent spinal care, as well as qualitative observations on an orthopaedic/neurosurgical ward, in operating theatres, and at CritiCall Ontario’s call centre.

Results

Several themes were identified and organized into categories that range from inter-professional collaboration through to issues of hospital-level resources and the role of relationships between hospitals and external organizations at the provincial level. Underlying many of these issues is the nature of the medically complex emergent spine patient and the scientific evidentiary base upon which best practice care is delivered. Through the implementation of knowledge translation strategies facilitated from this research, a reduction of patient transfers out of province was observed in the one-year period following program implementation.

Conclusions

Our findings suggest that competing priorities at both the hospital and provincial level create challenges in the delivery of spinal care. Key stakeholders recognized spinal care as aligning with multiple priorities such as emergent/critical care, medical through surgical, acute through rehabilitative, disease-based (i.e. trauma, cancer), and wait times initiatives. However, despite newly implemented strategies, there continues to be increasing trends over time in the number of spinal CritiCall Ontario referrals. This reinforces the need for ongoing inter-professional efforts in care delivery that take into account the institutional contexts that may constrain individual or team efforts.

Keywords:
Spine care; Coordination of care; Competing priorities; Ethnography; Trauma knowledge translation