A Cluster Randomized Trial of the Effect of an Physician-Nurse Supplementary Triage Assistance Team (MDRN STAT) on Emergency Department Patient Wait Times
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Enrollment
- 6,300
- Locations
- 1
- Primary Endpoint
- Effectiveness of the MDRN STAT on emergency department wait times
Study Overview
Brief Summary
The primary objective of this study is to investigate whether the introduction of a physician-nurse supplementary triage assessment team (MDRN STAT) is effective in improving time-based performance indicators for wait times. Secondary objectives will examine the quality of patient care and health care worker satisfaction and the cost-effectiveness of the program
Detailed Description
In 2007, the Ontario Ministry of Health and Long-term Care (MOHLTC) declared emergency department wait-times a government priority. The crisis of overcrowding and access block has become an international epidemic, affecting developing countries in Europe, North America, and Australasia. The MOHLTC has targeted 23 Ontario hospitals' prolonged wait times. Sunnybrook Health Sciences Center has been selected. Therefore, this is a quality improvement study of patient wait-times and care.
During a 20-week period, the MDRN STAT will be present on randomly chosen weekdays (8:00-16:00) for 50 shifts. Wait-times, such as time from triage time to: physician assessment, stretcher occupation, treatment orders (drugs), investigation orders (laboratory, diagnostic imaging), investigation acquisition (diagnostic imaging), consultation, bed request, discharge from ED (i.e. length of stay (LOS)) time, will be analyzed. In addition, the left-without-being-seen rate (LWBS) and rate of return will be analyzed. These results will be compared to the Ontario wait-time strategy P4R targets, as well as the Canadian Triage Acuity Scale (CTAS guidelines). Economic analysis of this intervention will be done. The hospital will independently perform patient satisfaction surveys. Health care worker satisfaction survey data will be analyzed.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Health Services Research
- Masking
- None
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Patients arriving from 8:00-14:30 during a day here a MDRN STAT is assigned
Exclusion Criteria
- Not provided
Arms & Interventions
Interaction with MDRN STAT
Interaction with MDRNSTAT at triage to obtain orders for investigations and/or treatment
Intervention: Interaction with MDRN STAT (Behavioral)
Control: No MDRNSTAT
Control group
Intervention: No MDRNSTAT (Behavioral)
Outcomes
Primary Outcomes
Effectiveness of the MDRN STAT on emergency department wait times
Time Frame: Time from triage to time of discharge from ED
Secondary Outcomes
- Cost-Effectiveness of a MDRN STAT in the Emergency Department(6 months, of 50 MDRN STAT shifts, randomized with non-intervention)
Investigators
Ivy Cheng
Dr. Ivy Cheng
Sunnybrook Health Sciences Centre