P132: Optimizing a physician surge protocol to address emergency department wait times during times of increased patient demand

Abstract

Background: Emergency Department overcrowding remains a significant problem. Interventions have often focused on areas external to the ED, with patient flow in the ED receiving less attention. Efforts to address ED flow are complicated by daily fluctuations in patient volume and acuity. Our local protocol brings in additional physicians when internal metrics indicate patient demand can't be met by current physician resources (a ‘surge’ period). However, anecdotal evidence suggests a lack of satisfaction and efficacy. We therefore undertook a project to improve our local management of these surge periods. Aim Statement: To improve the effectiveness of an ED Physician Surge Protocol to allow for a physician scheduling strategy that is reflective of the needs of the ED. Measures & Design: This project consists of 3 phases. Phase 1 was an analysis of current surge metrics (including frequency, temporal patterns and physician response), with concurrent literature search to identify any best practices or easily addressable protocol changes, with first planned PDSA cycle. Phase 2 is a mixed methods survey of local staff to identify barriers and enablers of our current protocol, concurrent with a national survey of current practices. Phase 3 will be the implementation of a revised protocol, followed by a second mixed methods survey and analysis of metrics of interest. Evaluation/Results: Analysis of surge data (Oct 2018-Oct 2019) demonstrated a high volume of surges per month (78.7 +/- 10.9), highest at Foothills Medical Centre (94.3). Across all sites, afternoon periods had highest frequency of surges (absolute peak 1400 - 1500) with a secondary peak 2200–2300, both peaks occurring most frequently on weekends (Fri-Sun) However, physician response to surge calls was < 10% (5.8-9.1%), with no discernable temporal pattern, even accounting for the significant number of automatic surge calls cancelled by clinicians. Analysis of data, in addition to literature review and engagement with senior administration suggested no immediate protocol changes, therefore project moved to 2nd phase. This phase is currently in progress, with planned analysis using Pareto Chart methodology. Discussion/Impact: Our initial data clearly demonstrates that current procedures are inadequate to address this ongoing issue, with no readily apparent solutions. Analysis of local barriers and enablers is currently underway, in addition to a national survey, with the results expected to inform an extensive redesign of current procedures.