A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial
BackgroundDespite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Dev...
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2022-03-01
|
| Series: | JMIR Research Protocols |
| Online Access: | https://www.researchprotocols.org/2022/3/e30454 |
| _version_ | 1827858552341921792 |
|---|---|
| author | Hensley H Mariathas Oliver Hurley Nahid Rahimipour Anaraki Christina Young Christopher Patey Paul Norman Kris Aubrey-Bassler Peizhong Peter Wang Veeresh Gadag Hai V Nguyen Holly Etchegary Farah McCrate John C Knight Shabnam Asghari |
| author_facet | Hensley H Mariathas Oliver Hurley Nahid Rahimipour Anaraki Christina Young Christopher Patey Paul Norman Kris Aubrey-Bassler Peizhong Peter Wang Veeresh Gadag Hai V Nguyen Holly Etchegary Farah McCrate John C Knight Shabnam Asghari |
| author_sort | Hensley H Mariathas |
| collection | DOAJ |
| description |
BackgroundDespite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Development countries. From a patient’s perspective, this challenge has been described as “patients wait in pain or discomfort for hours before being seen at EDs.” To overcome the challenge of increased wait times, we developed an innovative ED management platform called SurgeCon that was designed based on continuous quality improvement principles to maintain patient flow and mitigate the impact of patient surge on ED efficiency. The SurgeCon quality improvement intervention includes a protocol-driven software platform, restructures ED organization and workflow, and aims to establish a more patient-centric environment. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador, and found that there was a 32% reduction in ED wait times.
ObjectiveThe primary objective of this trial is to determine the effects of SurgeCon on ED performance by assessing its impact on length of stay, the time to a physician’s initial assessment, and the number of patients leaving the ED without being seen by a physician. The secondary objectives of this study are to evaluate SurgeCon’s effects on patient satisfaction and patient-reported experiences with ED wait times and its ability to create better-value care by reducing the per-patient cost of delivering ED services.
MethodsThe implementation of the intervention will be assessed using a comparative effectiveness-implementation hybrid design. This type of hybrid design is known to shorten the amount of time associated with transitioning interventions from being the focus of research to being used for practice and health care services. All EDs with 24/7 on-site physician support (category A hospitals) will be enrolled in a 31-month, pragmatic, stepped wedge cluster randomized trial. All clusters (hospitals) will start with a baseline period of usual care and will be randomized to determine the order and timing of transitioning to intervention care until all hospitals are using the intervention to manage and operationalize their EDs.
ResultsData collection for this study is continuing. As of February 2022, a total of 570 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. The first of the 4 EDs was randomly selected, and it is currently using SurgeCon’s eHealth platform and applying efficiency principles that have been learned through training since September 2021. The second randomly selected site will begin intervention implementation in winter 2022.
ConclusionsBy assessing the impact of SurgeCon on ED services, we hope to be able to improve wait times and create better-value ED care in this health care context.
Trial RegistrationClinicalTrials.gov NCT04789902; https://clinicaltrials.gov/ct2/show/NCT04789902
International Registered Report Identifier (IRRID)DERR1-10.2196/30454 |
| first_indexed | 2024-03-12T12:55:50Z |
| format | Article |
| id | doaj.art-b6d1b7898feb4fbfa76de61fad2cf632 |
| institution | Directory Open Access Journal |
| issn | 1929-0748 |
| language | English |
| last_indexed | 2024-03-12T12:55:50Z |
| publishDate | 2022-03-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Research Protocols |
| spelling | doaj.art-b6d1b7898feb4fbfa76de61fad2cf6322023-08-28T21:08:47ZengJMIR PublicationsJMIR Research Protocols1929-07482022-03-01113e3045410.2196/30454A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized TrialHensley H Mariathashttps://orcid.org/0000-0001-6007-4763Oliver Hurleyhttps://orcid.org/0000-0003-1989-7543Nahid Rahimipour Anarakihttps://orcid.org/0000-0002-1578-6494Christina Younghttps://orcid.org/0000-0002-8294-0324Christopher Pateyhttps://orcid.org/0000-0002-7222-2193Paul Normanhttps://orcid.org/0000-0002-9734-5528Kris Aubrey-Basslerhttps://orcid.org/0000-0001-8680-6838Peizhong Peter Wanghttps://orcid.org/0000-0002-0682-6861Veeresh Gadaghttps://orcid.org/0000-0002-1572-607XHai V Nguyenhttps://orcid.org/0000-0002-2578-170XHolly Etchegaryhttps://orcid.org/0000-0001-9673-0726Farah McCratehttps://orcid.org/0000-0001-9632-076XJohn C Knighthttps://orcid.org/0000-0003-4327-7272Shabnam Asgharihttps://orcid.org/0000-0002-4970-0978 BackgroundDespite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Development countries. From a patient’s perspective, this challenge has been described as “patients wait in pain or discomfort for hours before being seen at EDs.” To overcome the challenge of increased wait times, we developed an innovative ED management platform called SurgeCon that was designed based on continuous quality improvement principles to maintain patient flow and mitigate the impact of patient surge on ED efficiency. The SurgeCon quality improvement intervention includes a protocol-driven software platform, restructures ED organization and workflow, and aims to establish a more patient-centric environment. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador, and found that there was a 32% reduction in ED wait times. ObjectiveThe primary objective of this trial is to determine the effects of SurgeCon on ED performance by assessing its impact on length of stay, the time to a physician’s initial assessment, and the number of patients leaving the ED without being seen by a physician. The secondary objectives of this study are to evaluate SurgeCon’s effects on patient satisfaction and patient-reported experiences with ED wait times and its ability to create better-value care by reducing the per-patient cost of delivering ED services. MethodsThe implementation of the intervention will be assessed using a comparative effectiveness-implementation hybrid design. This type of hybrid design is known to shorten the amount of time associated with transitioning interventions from being the focus of research to being used for practice and health care services. All EDs with 24/7 on-site physician support (category A hospitals) will be enrolled in a 31-month, pragmatic, stepped wedge cluster randomized trial. All clusters (hospitals) will start with a baseline period of usual care and will be randomized to determine the order and timing of transitioning to intervention care until all hospitals are using the intervention to manage and operationalize their EDs. ResultsData collection for this study is continuing. As of February 2022, a total of 570 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. The first of the 4 EDs was randomly selected, and it is currently using SurgeCon’s eHealth platform and applying efficiency principles that have been learned through training since September 2021. The second randomly selected site will begin intervention implementation in winter 2022. ConclusionsBy assessing the impact of SurgeCon on ED services, we hope to be able to improve wait times and create better-value ED care in this health care context. Trial RegistrationClinicalTrials.gov NCT04789902; https://clinicaltrials.gov/ct2/show/NCT04789902 International Registered Report Identifier (IRRID)DERR1-10.2196/30454https://www.researchprotocols.org/2022/3/e30454 |
| spellingShingle | Hensley H Mariathas Oliver Hurley Nahid Rahimipour Anaraki Christina Young Christopher Patey Paul Norman Kris Aubrey-Bassler Peizhong Peter Wang Veeresh Gadag Hai V Nguyen Holly Etchegary Farah McCrate John C Knight Shabnam Asghari A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial JMIR Research Protocols |
| title | A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial |
| title_full | A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial |
| title_fullStr | A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial |
| title_full_unstemmed | A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial |
| title_short | A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial |
| title_sort | quality improvement emergency department surge management platform surgecon protocol for a stepped wedge cluster randomized trial |
| url | https://www.researchprotocols.org/2022/3/e30454 |
| work_keys_str_mv | AT hensleyhmariathas aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT oliverhurley aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT nahidrahimipouranaraki aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT christinayoung aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT christopherpatey aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT paulnorman aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT krisaubreybassler aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT peizhongpeterwang aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT veereshgadag aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT haivnguyen aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT hollyetchegary aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT farahmccrate aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT johncknight aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT shabnamasghari aqualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT hensleyhmariathas qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT oliverhurley qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT nahidrahimipouranaraki qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT christinayoung qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT christopherpatey qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT paulnorman qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT krisaubreybassler qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT peizhongpeterwang qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT veereshgadag qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT haivnguyen qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT hollyetchegary qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT farahmccrate qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT johncknight qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial AT shabnamasghari qualityimprovementemergencydepartmentsurgemanagementplatformsurgeconprotocolforasteppedwedgeclusterrandomizedtrial |