A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial

• Published in: JMIR Research Protocols
• Main Authors: 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
• Format: Article in Journal/Newspaper
• Language: English
• Published: JMIR Publications 2022
• Subjects: Medicine; R; Computer applications to medicine. Medical informatics; R858-859.7; Canada; Newfoundland
• Online Access: https://doi.org/10.2196/30454; https://doaj.org/article/b6d1b7898feb4fbfa76de61fad2cf632

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 ...