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{
    "pk": 12390,
    "title": "SurgeCon: Priming a Community Emergency Department for Patient Flow Management",
    "subtitle": null,
    "abstract": "Introduction: \nCanadian emergency departments (ED) are struggling to provide timely emergency care. Very few studies have assessed attempts to improve ED patient flow in the rural context. We assessed the impact of SurgeCon, an ED patient-management protocol, on total patient visits, patients who left without being seen (LWBS), length of stay for departed patients (LOSDep), and physician initial assessment time (PIA) in a rural community hospital ED.\nMethods: \nWe implemented a set of commonly used methods for increasing ED efficiency with an innovative approach over 45 months. Our intervention involved seven parts comprised of an external review, Lean training, fast track implementation, patient-centeredness approach, door-to-doctor approach, performance reporting, and an action-based surge capacity protocol. We measured key performance indicators including total patient visits (count), PIA (minutes), LWBS (percentage), and LOSDep (minutes) before and after the SurgeCon intervention. We also performed an interrupted time series (ITS) analysis.\nResults: \nDuring the study period, 80,709 people visited the ED. PIA decreased from 104.3 (±9.9) minutes to 42.2 (±8.1) minutes, LOSDep decreased from 199.4 (±16.8) minutes to 134.4(±14.5) minutes, and LWBS decreased from 12.1% (±2.2) to 4.6% (±1.7) despite a 25.7% increase in patient volume between pre-intervention and post-intervention stages. The ITS analysis revealed a significant level change in PIA – 19.8 minutes (p<0.01), and LWBS – 3.8% (0.02), respectively. The change over time decreased by 2.7 minutes/month (p< 0.001), 3.0 minutes/month (p<0.001) and 0.4%/month (p<0.001) for PIA, LOSDep, and LWBS, after the intervention.\nConclusion:\n SurgeCon improved the key wait-time metrics in a rural ED in a country where average wait times continue to rise. The SurgeCon platform has the potential to improve ED efficiency in community hospitals with limited resources.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Emergency Medicine"
        },
        {
            "word": "Emergency Room Wait Times"
        },
        {
            "word": "Patient flow"
        }
    ],
    "section": "Emergency Department Operations",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/85z9x3rb",
    "frozenauthors": [
        {
            "first_name": "Christopher",
            "middle_name": "",
            "last_name": "Patey",
            "name_suffix": "",
            "institution": "Memorial University of Newfoundland, Discipline of Family Medicine, St. John’s, Newfoundland",
            "department": "None"
        },
        {
            "first_name": "Paul",
            "middle_name": "",
            "last_name": "Norman",
            "name_suffix": "",
            "institution": "Eastern Health, Carbonear Institute for Rural Research and Innovation by the Sea, Carbonear General Hospital, Carbonear, Newfoundland",
            "department": "None"
        },
        {
            "first_name": "Mehdee",
            "middle_name": "",
            "last_name": "Araee",
            "name_suffix": "",
            "institution": "Memorial University of Newfoundland, Discipline of Family Medicine, St. John’s, Newfoundland",
            "department": "None"
        },
        {
            "first_name": "Shabnam",
            "middle_name": "",
            "last_name": "Asghari",
            "name_suffix": "",
            "institution": "Memorial University of Newfoundland, Discipline of Family Medicine, St. John’s, Newfoundland",
            "department": "None"
        },
        {
            "first_name": "Thomas",
            "middle_name": "",
            "last_name": "Heeley",
            "name_suffix": "",
            "institution": "Memorial University of Newfoundland, Discipline of Family Medicine, St. John’s, Newfoundland",
            "department": "None"
        },
        {
            "first_name": "Sarah",
            "middle_name": "",
            "last_name": "Boyd",
            "name_suffix": "",
            "institution": "Memorial University of Newfoundland, Discipline of Family Medicine, St. John’s, Newfoundland",
            "department": "None"
        },
        {
            "first_name": "Oliver",
            "middle_name": "",
            "last_name": "Hurley",
            "name_suffix": "",
            "institution": "Memorial University of Newfoundland, Discipline of Family Medicine, St. John’s, Newfoundland",
            "department": "None"
        },
        {
            "first_name": "Kris",
            "middle_name": "",
            "last_name": "Aubrey-Bassler",
            "name_suffix": "",
            "institution": "Memorial University of Newfoundland, Discipline of Family Medicine, St. John’s, Newfoundland",
            "department": "None"
        }
    ],
    "date_submitted": "2019-01-10T13:47:05Z",
    "date_accepted": "2019-01-10T13:47:05Z",
    "date_published": "2019-07-01T19:48:30Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/12390/galley/6590/download/"
        }
    ]
}