Richard Fleet1, Catherine Turgeon-Pelchat2, Fatoumata Korika Tounkara2, Jean-Guy Trottier3, Jean Ouellet4, Luc Lapointe2, Marie-Pierre Renaud2, Jean-Paul Fortin5. 1. Chaire de recherche en médecine d'urgence Université Laval, Centre intégré de santé et de services sociaux Chaudière-Appalaches, Québec, Qué. ; Centre de recherche sur les soins et les services de première ligne, Institut universitaire de première ligne en santé et services sociaux, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Qué. 2. Chaire de recherche en médecine d'urgence Université Laval, Centre intégré de santé et de services sociaux Chaudière-Appalaches, Québec, Qué. 3. Centre de santé et de services sociaux de l'Hématite, Fermont, Qué. 4. Direction de l'enseignement en région, vice-décanat à la responsabilité sociale, Université Laval, Québec, Qué. 5. Centre de recherche sur les soins et les services de première ligne, Institut universitaire de première ligne en santé et services sociaux, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Qué.
Abstract
INTRODUCTION: The goal of this study was to meet a small, remote emergency department's need to reflect on the minimum threshold of services to offer. The study's main objectives were to 1) provide a statistical profile of the emergency services in Fermont, Quebec, 2) assess the staff's and users' perception of the threshold of services offered and 3) propose solutions for improving care and services. METHODS: This case study was conducted with a participatory approach and a mixed methodology. We compared the results from a questionnaire on the emergency services that was validated during a previous study with the results concerning the other rural emergency services in Quebec as well as with national and provincial recommendations. The questionnaire concerned users' sociodemographic characteristics, the hospital's and the emergency services' descriptors, the services available locally, and the physician and nurse staff. Interviews were also carried out with 33 people (health care professionals, policy-makers and citizens). RESULTS: Fermont's emergency department is smaller than the average rural emergency department in Quebec. They have resources that are in some respects comparable to those of other emergency departments and in line with the recommendations; in other respects, their resources are rather limited. Respondents emphasized how important it is to take into account the environment's specific features when establishing the minimum threshold of services. The proposed solutions would promote collaboration, break down silos within professional practice and focus on training. CONCLUSION: Fermont's case aside, this exploratory case study highlights how important it is to adopt a pluralistic, participatory and local approach in order to support reflection on the minimum threshold of services in remote emergency departments and to improve their overall performance.
INTRODUCTION: The goal of this study was to meet a small, remote emergency department's need to reflect on the minimum threshold of services to offer. The study's main objectives were to 1) provide a statistical profile of the emergency services in Fermont, Quebec, 2) assess the staff's and users' perception of the threshold of services offered and 3) propose solutions for improving care and services. METHODS: This case study was conducted with a participatory approach and a mixed methodology. We compared the results from a questionnaire on the emergency services that was validated during a previous study with the results concerning the other rural emergency services in Quebec as well as with national and provincial recommendations. The questionnaire concerned users' sociodemographic characteristics, the hospital's and the emergency services' descriptors, the services available locally, and the physician and nurse staff. Interviews were also carried out with 33 people (health care professionals, policy-makers and citizens). RESULTS: Fermont's emergency department is smaller than the average rural emergency department in Quebec. They have resources that are in some respects comparable to those of other emergency departments and in line with the recommendations; in other respects, their resources are rather limited. Respondents emphasized how important it is to take into account the environment's specific features when establishing the minimum threshold of services. The proposed solutions would promote collaboration, break down silos within professional practice and focus on training. CONCLUSION: Fermont's case aside, this exploratory case study highlights how important it is to adopt a pluralistic, participatory and local approach in order to support reflection on the minimum threshold of services in remote emergency departments and to improve their overall performance.