Temporal Patterns of Healthcare Provider Referrals in an Emergency Department Research Study

Area of Science:

• Emergency Medicine
• Clinical Research Operations
• Substance Use Disorder Treatment

Background:

• Emergency departments (EDs) face workflow challenges impacting clinical research participation.
• The Evaluating Microdosing in the Emergency Department (EMED) study aims to optimize buprenorphine/naloxone initiation from EDs.
• Understanding healthcare provider referral patterns (HCPRs) is crucial for efficient research engagement.

Purpose of the Study:

• To quantify temporal variations in HCPRs by month, day of the week, and shift.
• To adjust referral rates based on research assistant availability.
• To identify provider-specific referral patterns within the EMED study.

Main Methods:

• Retrospective analysis of 2,244 HCPRs to the EMED study (July 2021-December 2023) at Vancouver General Hospital ED.
• Analysis of referral timing and provider type during research assistant coverage periods (morning, evening, overnight).
• Calculation of referral frequency density and Poisson regression to compare rates across temporal factors, adjusting for research assistant hours.

Main Results:

• Registered nurses accounted for 85.9% of HCPRs, followed by physicians (10.2%).
• Referral rates varied significantly by month (e.g., higher in December, lower in September) and day of the week (e.g., higher on Thursdays and Fridays).
• Morning shifts showed higher referral rates compared to evenings, and overnights had the lowest rates. Nurses' referrals increased after October 2022 following engagement efforts.

Conclusions:

• HCPRs to the EMED study exhibit distinct temporal clustering by month, day, and shift, even after accounting for research assistant availability.
• Registered nurses are the main contributors to referrals, with activity potentially influenced by engagement strategies.
• Identified patterns can guide future engagement approaches, especially for underrepresented provider groups.