Improving Indigenous health equity within the emergency department: a global review of interventions.

INTRODUCTION: Indigenous health equity interventions situated within emergency care settings remain underexplored, despite their potential to influence patient care satisfaction and empowerment. This study aimed to systematically review and identify Indigenous equity interventions and their outcomes within acute care settings, which can potentially be utilized to improve equity within Canadian healthcare for Indigenous patients. METHODS: A database search was completed of Medline, PubMed, Embase, Google Scholar, Scopus and CINAHL from inception to April 2023. For inclusion in the review, articles were interventional and encompassed program descriptions, evaluations, or theoretical frameworks within acute care settings for Indigenous patients. We evaluated the methodological quality using both the Joanna Briggs Institute checklist and the Ways Tried and True framework. RESULTS: Our literature search generated 122 publications. 11 articles were selected for full-text review, with five included in the final analysis. Two focusing on Canadian First Nations populations and three on Aboriginal Australians. The main intervention strategies included cultural safety training, integration of Indigenous knowledge into care models, optimizing waiting-room environments, and emphasizing sustainable evaluation methodologies. The quality of the interventions was varied, with the most promising studies including Indigenous perspectives and partnerships with local Indigenous organizations. CONCLUSIONS: Acute care settings, serving as the primary point of access to health care for many Indigenous populations, are well-positioned to implement health equity interventions such as cultural safety training, Indigenous knowledge integration, and optimization of waiting room environments, combined with sustainable evaluation methods. Participatory discussions with Indigenous communities are needed to advance this area of research and determine which interventions are relevant and appropriate for their local context.

RéSUMé: INTRODUCTION: Les interventions sur l'équité en santé des Autochtones dans les milieux de soins d'urgence demeurent sous-explorées, malgré leur potentiel d'influencer la satisfaction des patients et leur autonomisation. Cette étude visait à examiner et à déterminer systématiquement les interventions en matière d'équité envers les Autochtones et leurs résultats dans les milieux de soins de courte durée, qui pourraient être utilisés pour améliorer l'équité au sein des soins de santé canadiens pour les patients autochtones. MéTHODES: Une recherche dans la base de données a été effectuée de Medline, PubMed, Embase, Google Scholar, Scopus et CINAHL de la création à avril 2023. Pour être inclus dans la revue, les articles étaient interventionnels et comprenaient des descriptions de programmes, des évaluations ou des cadres théoriques dans les milieux de soins de courte durée pour les patients autochtones. Nous avons évalué la qualité méthodologique à l'aide de la liste de contrôle de l'Institut Joanna Briggs et du cadre Ways Tried and True. RéSULTATS: Notre recherche documentaire a généré 122 publications. 11 articles sélectionnés pour la revue de texte intégral, dont cinq inclus dans l'analyse finale. Deux se concentrent sur les populations des Premières nations canadiennes et trois sur les Australiens autochtones. Les principales stratégies d'intervention comprenaient la formation sur la sécurité culturelle, l'intégration des connaissances autochtones dans les modèles de soins, l'optimisation des environnements des salles d'attente et l'accent mis sur les méthodes d'évaluation durables. La qualité des interventions était variée, avec les études les plus prometteuses, y compris les perspectives autochtones et les partenariats avec les organisations autochtones locales. CONCLUSIONS: Les établissements de soins de courte durée, qui servent de principal point d'accès aux soins de santé pour de nombreuses populations autochtones, sont bien placés pour mettre en œuvre des interventions en matière d'équité en santé, comme la formation en sécurité culturelle, l'intégration des connaissances autochtones, l'optimisation des environnements des salles d'attente, associée à des méthodes d'évaluation durables. Discussions participatives avec Les communautés autochtones sont nécessaires pour faire avancer ce domaine de recherche et déterminer quelles interventions sont pertinentes et appropriées pour leur contexte local.

Overcrowding in emergency departments: an overview of reviews describing global solutions and their outcomes.

Emergency Department (ED) crowding is defined as a situation wherein the demands of emergency services overcome the ability of a department to provide high-quality care within an appropriate time frame. There is a need for solutions, as the harms of crowding impact patients, staff, and healthcare spending. An overview of ED crowding was previously published by our group, which outlines these global issues. The problem of overcrowding in emergency departments has emerged as a global public health concern, and several healthcare agencies have addressed the issue and proposed possible solutions at each level of emergency care. There is no current literature summarizing the extensive research on interventions and solutions, thus there is a need for data synthesis to inform policymakers in this field. The aim of this overview was to summarize the interventions at each level of emergency care: input, throughput, and output. The methodology was supported by the current PRIOR statement for an overview of reviews. The study summarized twenty-seven full-text systematic reviews, which encompassed three hundred and eight primary studies. The results of the summary displayed a requirement for increasing studies in input and output interventions, as these showed the best outcomes with regard to ED crowding metrics. Moreover, the results displayed heterogeneous results at each level of ED care; these reflected that generally solutions have not been matched to specific problems facing regional centres. Thus, individual factors need to be considered when implementing solutions in Emergency Departments.

Examining Indigenous emergency care equity projects: a scoping review protocol.

INTRODUCTION: Indigenous peoples across the globe face inequitable access to high-quality care. Emergency departments are the first point of access for many Indigenous peoples and are the interface between the individual and the healthcare system. There is a reliance on emergency services due to a lack of primary healthcare, a history of mistreatment from providers and increased disease complexity. As such, a potential place for health equity reform is within these departments and other acute care settings. It is the purpose of this review to determine what projects have occurred that address emergency care inequities in four countries such as Australia, Canada, New Zealand and the USA and explore their successes and failures. METHODS AND ANALYSIS: Using search strategies developed with a research librarian, publications will be identified from indexed databases including Medline, Embase, Web of Science, Cochrane Central, CINAHL and Scopus. Grey literature will also be searched and scanned for inclusion. To be included in the review, articles must describe interventions developed to address Indigenous health equity occurring within emergency care settings. Articles will include both programme descriptions and programme evaluations and be quality appraised by analysing study design and Indigenous research methodologies. ETHICS AND DISSEMINATION: This review does not require ethics approval. This protocol describes a review that attempts to map Indigenous health equity interventions taking place within emergency care settings. It will contribute to Indigenous health scholarship and equity research. Results will be made available in multiple dissemination methods to ensure accessibility by researchers and community members.

Emergency department crowding: an overview of reviews describing measures causes, and harms.

Crowding in Emergency Departments (EDs) has emerged as a global public health crisis. Current literature has identified causes and the potential harms of crowding in recent years. The way crowding is measured has also been the source of emerging literature and debate. We aimed to synthesize the current literature of the causes, harms, and measures of crowding in emergency departments around the world. The review is guided by the current PRIOR statement, and involved Pubmed, Medline, and Embase searches for eligible systematic reviews. A risk of bias and quality assessment were performed for each review, and the results were synthesized into a narrative overview. A total of 13 systematic reviews were identified, each targeting the measures, causes, and harms of crowding in global emergency departments. Key among the results is that the measures of crowding were heterogeneous, even in geographically proximate areas, and that temporal measures are being utilized more frequently. It was identified that many measures are associated with crowding, and the literature would benefit from standardization of these metrics to promote improvement efforts and the generalization of research conclusions. The major causes of crowding were grouped into patient, staff, and system-level factors; with the most important factor identified as outpatient boarding. The harms of crowding, impacting patients, healthcare staff, and healthcare spending, highlight the importance of addressing crowding. This overview was intended to synthesize the current literature on crowding for relevant stakeholders, to assist with advocacy and solution-based decision making.