Clinical trial NCT00991471: The Effect of an Physician-Nurse Supplementary Triage Assistance Team on Emergency Department Patient Wait Times
Official title: A Cluster Randomized Trial of the Effect of an Physician-Nurse Supplementary Triage Assistance Team (MDRN STAT) on Emergency Department Patient Wait Times
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Emergencies
Keywords: Emergency Department Wait Times
Physician Nurse at Triage
Overcrowding
CostEffectiveness
Lead sponsor: Sunnybrook Health Sciences Centre
Sponsor class: OTHER
First posted: 2009-10-08
Enrollment: 6300
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

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.

Eligibility criteria: Inclusion Criteria:

* Patients arriving from 8:00-14:30 during a day here a MDRN STAT is assigned

Exclusion Criteria:

* None

Primary outcomes:
measure: Effectiveness of the MDRN STAT on emergency department wait times
timeFrame: Time from triage to time of discharge from ED
Secondary outcomes:
measure: Cost-Effectiveness of a MDRN STAT in the Emergency Department
timeFrame: 6 months, of 50 MDRN STAT shifts, randomized with non-intervention
Other outcomes:
Locations:
city: Toronto
country: Canada
facility: Sunnybrook Health Sciences Center
state: Ontario
Study officials:
affiliation: Sunnybrook Hospital Emergency Department
name: Ivy Cheng, FRCP
role: PRINCIPAL_INVESTIGATOR
References:
citation: Cheng I, Lee J, Mittmann N, Tyberg J, Ramagnano S, Kiss A, Schull M, Kerr F, Zwarenstein M. Implementing wait-time reductions under Ontario government benchmarks (Pay-for-Results): a Cluster Randomized Trial of the Effect of a Physician-Nurse Supplementary Triage Assistance team (MDRNSTAT) on emergency department patient wait times. BMC Emerg Med. 2013 Nov 11;13:17. doi: 10.1186/1471-227X-13-17.