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Yau, May

Introduction: Computed tomography (CT) access is associated with an earlier diagnosis and initiation of treatment. As part of the clinical pathway, inadequate CT accessibility can contribute towards rural health inequities. A dedicated study on the accessibility of CT in rural Alberta, and perceived impact on patients has not been conducted previously. Methods: Physicians who practice emergency medicine out of one or more rural facilities in Alberta were invited to participate in a mixed methods survey on the accessibility of CT. A process map was created to provide an overview on CT access from rural emergency departments (EDs). Results: Thirteen physicians responded to the survey. Four respondents practice at a facility with onsite CT but limited hours of operation, and nine respondents practice at facilities without onsite CT. Respondents rated the value of CT as equal or higher than their accessibility satisfaction scores. Patients are often held in the emergency department (ED) waiting for CT to resume service, or are transferred to a referral facility for their scan. Distance and Emergency Medical Services (EMS) shortages are common sources of delays, which are perceived to contribute towards poorer patient outcomes. Discussion: CT infrastructure is limited in rural Alberta. Accessibility is further limited by hours of operation, and scan restrictions. High perceived value and low satisfaction indicate the demand for CT exceeds service levels in rural areas. Limited hours of operation for CT obstructs patient flow at all facilities within the catchment area. Poor CT accessibility is a barrier to stroke triage, thus, patients from select rural communities experience greater difficulty accessing treatment within the optimal therapeutic window. Frequent use of EMS for offsite CT transfers has a siphoning impact on limited resources, which have already become more constrained due to Covid-19. Extending CT service hours could preserve EMS crews for emergency patient care, and reduce patient holds in the ED; freeing resources to improve patient flow, and reduce ED wait times. Limitations: Responses are limited to opportunistic data, and subject to recall bias. Due to a low response rate, conclusions cannot be drawn regarding which communities experience the greatest inequities in health access compared to others. Recommendations: Further investigation on the feasibility of extending service hours for existing CT scanners is recommended. Facilities without onsite CT can focus on the frequency of imaging related EMS transfers, and access to acute stroke resources to determine if the addition of an onsite scanner can be justified.

Text

University of British Columbia. SURG 560

Vancouver : University of British Columbia Library

10.14288/1.0431192

Medicine, Faculty of

Unreviewed

http://creativecommons.org/licenses/by-nc-nd/4.0/