The Effect of an Physician-Nurse Supplementary Triage Assistance Team on Emergency Department Patient Wait Times

Study Overview
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Brief Summary
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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
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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.

Official Title
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A Cluster Randomized Trial of the Effect of an Physician-Nurse Supplementary Triage Assistance Team (MDRN STAT) on Emergency Department Patient Wait Times

Conditions
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Emergencies

Intervention / Treatment
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* Behavioral: Interaction with MDRN STAT
* Behavioral: No MDRNSTAT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients arriving from 8:00-14:30 during a day here a MDRN STAT is assigned Exclusion Criteria: None
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Interaction with MDRN STAT<br>Interaction with MDRNSTAT at triage to obtain orders for investigations and/or treatment | Behavioral: Interaction with MDRN STAT<br>* Interaction with MDRNSTAT at triage to obtain orders for investigations and/or treatment<br>|
| Experimental: Control: No MDRNSTAT<br>Control group | Behavioral: No MDRNSTAT<br>* Standard management of nurse-only triage for assignment of CTAS<br>* Other names: Standard triage;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Effectiveness of the MDRN STAT on emergency department wait times |  | Time from triage to time of discharge from ED | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cost-Effectiveness of a MDRN STAT in the Emergency Department |  | 6 months, of 50 MDRN STAT shifts, randomized with non-intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Emergency Department Wait Times, Physician Nurse at Triage, Overcrowding, CostEffectiveness