ED Adaptive Staffing Study (FAST-ED)

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

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.

Study Overview

• Status: Recruiting
• Conditions: Emergency Medicine; Well-Being, Psychological
• Intervention / Treatment: Other: Staffing model

• Study Type: Observational
• Enrollment (Estimated): 5917

Contacts and Locations

• Study Contact: Name: Andrew Arcand, MD; Phone Number: 905-472-7373; Email: AArcand@oakvalleyhealth.ca
• Study Contact Backup: Name: Michelle Dimas, MSc; Phone Number: 6253 905-472-7373; Email: mdimas@oakvalleyhealth.ca

Study Locations

• Canada
  • Ontario
    • Markham, Ontario, Canada, L3P 7P3
      • Recruiting
      • Markham Stouffville Hospital
      • Contact: Michelle Dimas, MSc; Phone Number: 6253 9054727373; Email: mdimas@oakvalleyhealth.ca
      • Principal Investigator: Andrew Arcand, MD
      • Principal Investigator: Philip Moran, MD
      • Sub-Investigator: Michelle Dimas, MSc
      • Sub-Investigator: Jinal Patel, RN
      • Sub-Investigator: Ainslee Smith, RN
      • Sub-Investigator: Carissa Surujpaul, RN

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study will use a convenience sampling method, given that patients brought in by ambulance are at random and non-predictive.

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Primary Care Paramedic (PCP) Block; 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; Staffing the hospitals emergency department offload zone with a PCP or RN or current workflow.
Registered Nurse (RN) Block; 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; Staffing the hospitals emergency department offload zone with a PCP or RN or current workflow.
Current Workflow Block; The currently hospitals staffing models of the emergency department offload zone.

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Oak Valley Health

Study record dates

Study Major Dates

• Study Start (Actual): October 2, 2023
• Primary Completion (Estimated): March 1, 2024
• Study Completion (Estimated): September 1, 2024

Study Registration Dates

• First Submitted: June 23, 2023
• First Submitted That Met QC Criteria: June 30, 2023
• First Posted (Actual): July 10, 2023

Study Record Updates

• Last Update Posted (Actual): March 22, 2024
• Last Update Submitted That Met QC Criteria: March 20, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 148-2306

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Aggregate data and study results will be shared via publication and conference presentations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No