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Barriers to research in emergency medicine

Graham, Colin A.

European Journal of Emergency Medicine: June 2019 - Volume 26 - Issue 3 - p 149
doi: 10.1097/MEJ.0000000000000605

Department of Emergency Medicine, Chinese University of Hong Kong, Shatin, Hong Kong

Correspondence to Colin A Graham, Department of Emergency Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, e-mail:

Research is a core and critically important component of our discipline [12]. Emergency medicine was a latecomer to the concept of research, probably due in part to the clinical demands we face [3], with the development of the specialty lagging behind our major collaborators and competitors. Research in prehospital care arguably lags even further behind, with significant gaps in our knowledge and practice. What are the barriers to effective emergency medicine research?

First and foremost is our own belief that this is important. Emergency care has always been, and will always be, a service-focused specialty. This is something that we are rightly proud of, but we must also recognize that progress in emergency care can only occur if we complete high-quality research in our specialty. In many departments, research is seen as the preserve of the academic staff in the department, but the reality is that we need the contribution of everyone in the emergency department to move our research studies forward – in particular, by helping with recruitment to clinical trials.

Patient recruitment is the bugbear of any clinical researcher’s existence – without it, studies cannot be completed, and practice cannot be influenced. The UK National Health Service has made considerable inroads into establishing clinical research networks along with dedicated staff to help with recruitment in the clinical setting, and this has great potential to improve the research situation there. They have recognized that clinical service and clinical research go hand-in-hand, and they have embraced that – something that other clinical service providers would do well to acknowledge and take positive action to improve.

Academia cannot work in isolation from the clinical environment, and no more so than in emergency care. Other major challenges include adequate funding and consent for research in the emergency department, especially in emotionally charged situations and in our inherently time-limited setting. Dedicated research staff are important to give additional expertise and time for potential participants to have the fullest opportunity to consider the pros and cons of joining a clinical emergency trial.

Funding is vital to employ trained research staff and to facilitate high-quality data collection. Staff costs usually make up the majority of any research study budget, and given the challenges of recruitment, it is important to not underestimate staffing requirements when planning trial budgets. Formal training for research staff is critically important, especially when considering the increasing demands of good clinical practice in research.

At a strategic level, it is important for emergency medicine staff to be available to review [4] and constructively criticize grant applications for our specialty, because the alternative is that other specialists are asked to comment on our proposals. While this can add another useful perspective to a project, often their lack of understanding of the environment in which we work and the unique demands of the emergency research setting can be powerful limitations.

We have a long way to go to catch up with our more experienced research colleagues in other, more established, disciplines. However, more and better quality emergency care research is being presented and published [5–7], and we are making progress on defining the important research priorities and agendas for our own critically important specialty.

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Conflicts of interest

There are no conflicts of interest.

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1. Brabrand M, Graham CA. Emergency medicine research and the European Journal of Emergency Medicine. Eur J Emerg Med 2018;25:303.
2. Hung KK, Lo RS, Graham CA. Outcomes in emergency care research. Eur J Emerg Med 2017;24:1.
3. Graham CA. Emergency care systems: increasing pressures but little sustainability. Eur J Emerg Med 2017;24:157.
4. Graham CA. Reviewing papers for publication: privilege, pain, or perhaps a responsibility. Eur J Emerg Med 2017;24:79.
5. Graham CA. Changing directions for emergency medicine in 2018: from the ‘Beast from the East’ to the ‘Best in the West’. Eur J Emerg Med 2018;25:153.
6. Graham CA. Reflections on 2018. Eur J Emerg Med 2018;25:377.
7. Fernández-Guerrero IM, Martín-Sánchez FJ, Burillo-Putze G, Graham CA, Miró Ò. Analysis of the citation of articles published in the European Journal of Emergency Medicine since its foundation. Eur J Emerg Med 2019;26:65–70.
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