Anaraki Nahid Rahimipour, Jewer Jennifer, Hurley Oliver, Mariathas Hensley H, Young Christina, Norman Paul, Patey Christopher, Wilson Brenda, Etchegary Holly, Senior Dorothy, Asghari Shabnam
Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
Faculty of Business Administration, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
Implement Sci Commun. 2022 Mar 2;3(1):21. doi: 10.1186/s43058-021-00247-1.
Emergency departments (EDs) around the world are struggling with long wait times and overcrowding. To address these issues, a quality improvement program called SurgeCon was created to improve ED efficiency and patient satisfaction. This paper presents a framework for managing and evaluating the implementation of an ED surge management platform. Our framework builds on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to structure our approach and the Consolidated Framework for Implementation Research (CFIR) to guide our choice of outcome variables and scalability.
Four hospital EDs will receive the SurgeCon quality improvement intervention. Using a stepped wedge cluster design, each ED will be randomized to one of four start dates. Data will be collected before, during, and after the implementation of the intervention. RE-AIM will be used to guide the assessment of SurgeCon, and guided by CFIR, we will measure ED key performance indicators (KPI), patient-reported outcomes, and implementation outcomes related to SurgeCon's scalability, adaptability, sustainability, and overall costs. Participants in this study consist of patients who visit any of the four selected EDs during the study period, providers/staff, and health system managers. A mixed-methods approach will be utilized to evaluate implementation outcomes.
This study will provide important insight into the implementation and evaluation techniques to enhance uptake and benefits associated with an ED surge-management platform. The proposed framework bridges research and practice by involving researchers, practitioners, and patients in the implementation and evaluation process, to produce an actionable framework that others can follow. We anticipate that the implementation approach would be generalizable to program implementations in other EDs.
• Name of the registry: ClinicalTrials.gov • Trial registration number: NCT04789902 • Date of registration: 03/10/2021.
世界各地的急诊科都在为长时间等待和过度拥挤问题所困扰。为解决这些问题，创建了一个名为SurgeCon的质量改进项目，以提高急诊科效率和患者满意度。本文提出了一个用于管理和评估急诊科激增管理平台实施情况的框架。我们的框架以“覆盖、有效性、采用、实施和维持”（RE-AIM）框架为基础来构建我们的方法，并以实施研究综合框架（CFIR）来指导我们对结果变量和可扩展性的选择。
四家医院的急诊科将接受SurgeCon质量改进干预。采用阶梯式楔形整群设计，每个急诊科将被随机分配到四个开始日期之一。在干预实施前、实施期间和实施后收集数据。RE-AIM将用于指导对SurgeCon的评估，在CFIR的指导下，我们将测量急诊科关键绩效指标（KPI）、患者报告的结果以及与SurgeCon的可扩展性、适应性、可持续性和总体成本相关的实施结果。本研究的参与者包括在研究期间访问四家选定急诊科中的任何一家的患者、提供者/工作人员以及卫生系统管理人员。将采用混合方法来评估实施结果。
本研究将为实施和评估技术提供重要见解，以提高与急诊科激增管理平台相关的采用率和效益。拟议的框架通过让研究人员、从业者和患者参与实施和评估过程，将研究与实践联系起来，以产生一个其他人可以遵循的可操作框架。我们预计该实施方法将适用于其他急诊科的项目实施。
• 注册机构名称：ClinicalTrials.gov • 试验注册号：NCT04789902 • 注册日期：2021年10月3日。
