R. D. Adams1, Z. Morrison2, E. Cole1, J. Jansen3 1Queen Mary, University Of London,London, ENGLAND, United Kingdom 2University Of Aberdeen,Aberdeen, SCOTLAND, United Kingdom 3University Of Alabama at Birmingham,Birmingham, Alabama, USA
Introduction: Inclusive trauma systems have been shown to reduce mortality, when compared with exclusive systems. A trauma system is currently being developed in Scotland, a country with large rural areas. However, rural trauma systems face challenges; especially geography and low patient volume. The development of such a rural trauma system is a complex undertaking and understanding the views of service providers will be crucial.
The aim of this study was to conduct an exploratory evaluation, in order to identify key barriers and enablers to the development of an effective trauma system, from the perspective of rural healthcare professionals, to inform the effective implementation of a trauma system.
Methods: We undertook an initial scoping study using a qualitative case study research strategy to better understand the perceptions of rural healthcare professionals within a single setting; current trauma services within the North of Scotland due to be integrated into the planned trauma system. The study was conducted across rural general hospitals (RGH) in the North of Scotland, from April to June 2017, using an opportunistic sampling strategy to include hospital-based providers of rural trauma care across the region. Semi-structured interviews were conducted, recorded, and professionally transcribed. Thematic analysis was used to identify and group participant perspectives on the key barriers and enablers to the development of the new trauma system.
Results: We conducted 15 interviews with 18 participants (17 doctors and one nurse) across all six RGHs. Participants had a mean of 18 years trauma care experience.
Study participants described several barriers and enablers, across three themes. The first theme was quality of care and enablers included confidence in basic management, although, a perceived lack of change from current management was seen as a barrier.
The second theme was interfaces with the network, which included enablers, such as, a good interaction with other services and a single point of contact for referral. Barriers included challenges in referring to tertiary care.
The final theme was trauma within the wider healthcare system that included enablers such as an improved transport system, increased audit resource and coordinated clinical training. Barriers perceived were a rural staffing crisis and problematic transfer to further care.
Conclusion: This study provides a multifaceted insight into rural healthcare professionals’ perceptions regarding barriers and enablers to implementing a rural trauma system in Scotland. These included practical issues, such as retrieval, transfer and referral processes. More importantly, there appears to show a degree of uncertainty, discontent and disengagement towards 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 delivery of rural trauma systems.