ED Adaptive Staffing Study

Study Overview
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Brief Summary
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Emergency Departments (EDs) across Ontario are being inundated with unprecedented high patient volumes and a staffing shortage that directly impacts patient care and flow. An area of concern among EDs is the offload zone where patients are brought in by ambulance. EMS offload time is the time it takes paramedics to transfer a patient to the appropriate area within an emergency department and give hospital staff a summary of what concerns the patient is seeking care for. There are multiple factors that may delay this time, including limited staff in the offload area to complete the transfer process due to competing patient care responsibilities. The adaptive staffing model study will look to add a primary care paramedic (PCP) or a registered nurse (RN) in the offload zone during times of high ambulance volume (August to January) to help with patient care within the offload zone. This single-centered community hospital study will evaluate the benefits of having a PCP or RN, compared to the current model, on ambulance offload times, patient safety outcomes, patient treatment times, and staff well-being using three different models of staffing.

Official Title
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Feasibility and Evaluation of an Adaptive STaffing Model in a Community Emergency Department (FAST-ED)

Conditions
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Emergency Medicine, Well-Being, Psychological

Intervention / Treatment
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* Other: Staffing model


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients brought in by ambulance to hospitals emergency department offload area Exclusion Criteria: Patients not arriving to the hospitals emergency department offload area
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Primary Care Paramedic (PCP) Block<br>A PCP will be staffed in the emergency department offload zone 3 days a week (Monday, Wednesday, and Friday) on a 10am - 10pm shift, in addition to the standard staffing model. | Other: Staffing model<br>* Staffing the hospitals emergency department offload zone with a PCP or RN or current workflow.<br>|
| Registered Nurse (RN) Block<br>An experienced emergency department RN with triage training will be staffed in the emergency department offload zone 3 days a week (Monday, Wednesday, and Friday) in a 10am - 10pm shift, in addition to the standard staffing model | Other: Staffing model<br>* Staffing the hospitals emergency department offload zone with a PCP or RN or current workflow.<br>|
| Current Workflow Block<br>The currently hospitals staffing models of the emergency department offload zone. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Triage Time | The aim of this objective is to compare time to triage and time to transfer of care for three models of staffing. | 6 months | 
| Return to Service | The aim of this objective is to determine if an adaptive staffing model during peak volumes reduces ambulance offload times and return to service. | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to provider assessment |  | 6 months | 
| Provider Feedback Survey | Explore provider perceptions (ED staff and paramedics) of each model with the aim of determining which model provides better patient care during peak volumes. Participants will self-report their perceived barriers, challenges and benefits of the staffing interventions. | 6 months | 
| Time to treatment |  | 6 months | 
| Time to disposition |  | 6 months | 
| Number of incident reports | Patient safety events | 6 months | 
| Case costing |  | 6 months | 
| Well-being Index (questionnaire) | Explore staff and paramedic well-being on intervention model | 6 months |