title: Improving access to emergent spinal care through knowledge translation: an ethnographic study.
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.
authors.affiliation: Department of Family & Community Medicine, University of Toronto, 500 University Ave, 5th floor, Toronto, Ontario M5G 1 V7, Canada. fiona.webster@utoronto.ca.
authors.forename: Fiona
authors.initials: F
authors.lastname: Webster
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.forename: Kathleen
authors.initials: K
authors.lastname: Rice
authors.forename: Harsha
authors.initials: H
authors.lastname: Malempati
authors.forename: Khaled
authors.initials: K
authors.lastname: Fawaz
authors.forename: Fred
authors.initials: F
authors.lastname: Nicholls
authors.forename: Navindra
authors.initials: N
authors.lastname: Baldeo
authors.forename: Scott
authors.initials: S
authors.lastname: Reeves
authors.forename: Anoushka
authors.initials: A
authors.lastname: Singh
authors.forename: Henry
authors.initials: H
authors.lastname: Ahn
authors.forename: Howard
authors.initials: H
authors.lastname: Ginsberg
authors.forename: Albert J
authors.initials: AJ
authors.lastname: Yee
mesh_terms: D000328:Adult; D004638:Emergency Treatment; D005260:Female; D006292:Health Priorities; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D008297:Male; D009864:Ontario; D058996:Quality Improvement; D012017:Referral and Consultation; D013124:Spinal Injuries / Q000628:therapy*; D057170:Translational Research, Biomedical; D014218:Triage
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