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Did an emergency department flow optimization protocol reduce wait times? A multiple-site interrupted time series
Moein Yoosefi1, Aswathy Geetha Manukumar2, Hensley H Mariathas2
1Centre for Rural Health Studies, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada; Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John's, NL, Canada.
Objective:
This study aims to evaluate the effect of a surge protocol on the emergency department (ED) waiting times and the percentage of patients who leave without being seen in hospitals in the Eastern Health region in Newfoundland and Labrador (NL), Canada.
Methods:
Data for this study were obtained from electronic medical records of four emergency departments across NL. SurgeCon is a real-time, action-based electronic platform designed to monitor patient flow, support timely clinical decision-making, and prioritize patient-centred care. We evaluated the impact of the SurgeCon intervention using interrupted time series (ITS) analysis, examining key performance indicators including physician initial assessment time, length of stay (LOS), and the proportion of patients who left without being seen (LWBS). Outcomes were compared between a 12-month pre-intervention period (October 2020-September 2021) and a 12-month sustainment period (October 2023-September 2024).
Results:
At the three adherent sites, the level change at the onset of the sustainment period indicated higher values for all three outcomes compared with the control period: physician initial assessment time increased by 1 h 31 m (p < 0.001), LOS by 2 h 3 m (p < 0.001), and the odds of LWBS by a factor of 2.30 (p < 0.001), consistent with system-wide post-pandemic pressures. However, the slope change during the sustainment period was negative and statistically significant for all three outcomes, indicating progressive improvement over time: physician initial assessment time decreased by 2.28 min per month (p < 0.001), LOS by 2.6 min per month (p < 0.001), and the odds of LWBS by 5.3% per month (p < 0.001). In contrast, the non-adherent hospital exhibited worsening trends across all outcomes.
Conclusions:
Our study demonstrates that the SurgeCon intervention was associated with a significant improvement in ED wait times and the LWBS rate over time. Despite an initial rise in mean wait times, negative temporal trends indicate sustained gains over time, underscoring the value of structured surge management systems in enhancing ED performance.
