PRP163: SurgeCon: Measuring the effectiveness of an ED management platform through iCT design and implementation science

Shabnam Asghari, MD, PhD, MPH; Christopher Patey, MD, BSc, CCFP; Dorothy Senior; Anna Walsh, BSc; Oliver Hurley, M. Env.Sc.


Context: Canadian emergency departments (ED) have some of the longest wait times compared to many other first world countries. It is increasingly difficult for EDs in Canada to keep pace with patient demand. In Newfoundland and Labrador (NL), this increase in wait times is expected to be further exacerbated as a result of a family physician shortage and rapidly aging population.

Objective: The overall aim of this study is to test the effectiveness of the SurgeCon platform in improving ED wait times, patient outcomes, and system processes while also developing strategies that promote its scalability, sustainability, and successful implementation across the Canadian health system. Study Design: Comparative effectiveness-implementation hybrid design with a stepped-wedge 30-month cluster trial which will assign each hospital to a step through a random ordering process while engaging patients as research partners. Setting: Four EDs with 24/7 on-site physician support in the Eastern Health region of NL.

Dataset: Health administrative data will be extracted and analyzed alongside data collected through the SurgeCon platform.

Population studied: All individuals who will visit any of the four selected EDs during the study period will be included in the study. Patients who receive care at these EDs will be randomly selected for subsequent follow-up after they are discharged to collect information related to their experience in the ED and to determine their level of satisfaction with regard to staff and the care they received.

Intervention: The SurgeCon intervention includes three components; each of them integrating a series of quality improvement initiatives; 1. restructuring ED organization workflow (e.g., Door to Doctor Focus), 2. establish a patient-centric environment (e.g., improve the physical appearance of ED space), 3. e-health action-based ED management (e.g., Action-based protocol role assignment). We will support intervention implementation through staff training, performance data review, and recruiting SurgeCon champions.

Outcome Measures: Length of stay (LOS), physician initial assessment (PIA), left without being seen (LWBS), patient volume, patient satisfaction, and overall ED cost.

Expected Results/Outcomes: We anticipate that SurgeCon will reduce ED wait times, improve patient satisfaction, and will improve the value of emergency healthcare spending.
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Laura Mentch

The potential for changing the emergency department experience with this study is encouraging. How have users of the emergency department been involved with the design of this project? I was unfamiliar with the many acronyms that were used, the key at the bottom did not get my attention until my review of the poster was finished. The poster title confused me. In my field ED is an acronym for erectile dysfunction.

Oliver Hurley

Hi Laura, Thank you for your feedback and question. We have designed the study to give patients a variety of opportunities to engage with us, ranging from limited commitment (e.g. surveys) to full team membership. Our team`s patient principal knowledge user is a member of our executive committee and makes decisions that help direct research operations alongside researchers, clinicians, and policymakers. We also have a patient engagement working group who meet monthly and is co-led by our patient principal knowledge user. The working group includes researchers and other patient research partners who provide guidance on patient recruitment strategies, implementation monitoring, evaluation, data analysis and interpretation, and knowledge dissemination. Will be collecting patient satisfaction and experience survey data for the duration of the project which will be used to improve our intervention so that it addresses the needs and priorities of patients. Best regards, Oliver

Viv Ramsden 11/19/2020

This appears to have been a SPOR funded project. How, when and where were patients/families engaged in the research processes? How might that have changed the project?

Oliver Hurley

Hi Viv, Thank you for your question. Beyond what I have included in the response to Laura`s comment, here are a few other ways we have engaged patients and the impact they have had on the SurgeCon study. Prior to the commencement of the study, we consulted NLSUPPORT`s (Newfoundland and Labrador`s SPOR unit) patient advisory council to select outcomes using PCORI`s outcome selection process. The outcomes they selected became the primary outcomes measured during the study and helped determine the questions included in our patient satisfaction and experience survey. Our innovative clinical trial study design allows us to improve our intervention over the course of the study based on feedback and data analysis. Patient feedback will be assessed to determine if the intervention is helping to address patient needs and priorities and whether adjustments to certain components of the intervention need to be made. Also, we are going to be evaluating our patient engagement strategy using PCORI`s engagement rubric to ensure we are conducting research and engaging patients in an authentic manner that upholds the guiding principles of our engagement strategy (inclusiveness, support, mutual respect, and co-building). I hope this provides some insight as to how we engage patients and the impact they have on the study. Thanks, Oliver

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