Trial Review

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Trial registered on ANZCTR


Registration number
ACTRN12619000665134
Ethics application status
Approved
Date submitted
11/04/2019
Date registered
3/05/2019
Date last updated
14/08/2019
Date data sharing statement initially provided
3/05/2019
Type of registration
Prospectively registered

Titles & IDs
Public title
A multicentre, qualitative evaluation of the impact of advertised Emergency Department (ED) wait time on ED patients, potential patients and other stakeholders.
Scientific title
A multicentre, qualitative evaluation of the impact of advertised Emergency Department (ED) wait time on ED patients, potential patients and other stakeholders.
Secondary ID [1] 297960 0
Nil known
Universal Trial Number (UTN)
U1111-1231-5800
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Emergency Medicine 312354 0
Published Emergency Department wait times 312355 0
Private Emergency Medicine 312357 0
Condition category
Condition code
Emergency medicine 310914 310914 0 0
Other emergency care
Public Health 311149 311149 0 0
Health service research

Intervention/exposure
Study type
Observational
Patient registry
False
Target follow-up duration
Target follow-up type
Description of intervention(s) / exposure
Patients who attend emergency departments usually wait to be treated. This is called the emergency department wait time. This study is a qualitative exploration of the patient and stakeholder/referrer experience of waiting to see a doctor or nurse and whether there is value in providing approximate wait times to people (online access and waiting room access). It will also explore what people's interpretation of the meaning of wait time (and patient's interpretations of what constitutes treatment) and whether this is important information to consumers.

At a few facilities nationally and internationally, there is online streaming of predictive wait time information made available to patients and referrers. This is sometimes called the advertised wait time. (e.g. Cabrini Emergency Department, approximate wait time to be seen by a doctor = 33 minutes, patients waiting to be seen = 4). Most facilities in Australia currently aren't making patient wait times available in this manner. When advertised wait times are available and provided by individual hospitals (or state departments of health), they can be accessed online on hospital/health department websites and are sometimes displayed in patient waiting rooms. e.g. https://www.cabrini.com.au/patients-and-families/services/directory/emergency-department

Predictive information is generated by using previous and current patient administrative metadata (previous patient wait times) and calculated by complex mathematical algorithms. There is little data currently available regarding the accuracy of algorithms.

Most patients and consumers in this study will not have access to this type of data for their local hospital. A few will have attended a hospital where predicted wait times are displayed.

Patient and stakeholder/referrer interviews will be undertaken to explore a number of aspects related to wait times. We anticipate that interviews will take between 10 and 20 minutes per face-to-face or phone interview. There will be only one interview for each subject.

Patients in Emergency Departments will be asked: what wait times mean to them, whether it is important to patients to have approximate wait times available to them at point of care/need, how wait time information should be displayed and aspects of safety regarding wait times will be explored.

Paramedics/Ambulance Victoria controllers/diversion officers will be asked: what they perceive wait times to be, whether it is important to have approximate wait times available, whether this may facilitate load sharing, how wait times should be displayed and aspects of safety regarding wait times will be explored.

Consumer representatives will be asked: what wait times mean to them, whether it is important to patients to have approximate wait times available to them at point of care/need, how wait time information should be displayed and aspects of safety regarding wait times will be explored.

Health administrators will be asked: what wait times mean to them, any potential enablers or barriers, how wait time information should be displayed and aspects of safety regarding wait times will be explored.
Intervention code [1] 314179 0
Not applicable
Comparator / control treatment
Whilst we are obtaining data from sites that do and don't have advertised wait times, it is unlikely that these sites will be used for comparison. We are seeking broad community perspectives on wait times, rather than specifics about exposure to the concept. There may be some subgroup analysis between the two groups, however we are not attempting to establish a control group.
Control group
Uncontrolled

Outcomes
Primary outcome [1] 319738 0
Consumer perspective of ED wait time as assessed by semi-structured interview which will be recorded, transcribed and thematically analysed
Timepoint [1] 319738 0
Assessed at single point interview during ED visit (cross-sectional study) or at single point during volunteer community interviews
Secondary outcome [1] 369346 0
Paramedic perspective on what constitutes an ED wait time as assessed by semi-structured interview which will be recorded, transcribed and thematically analysed.
Timepoint [1] 369346 0
Assessed at single point interview during ED visit (cross-sectional study)
Secondary outcome [2] 369575 0
ED staff experience of advertised ED wait times as assessed by semi-structured interview which will be recorded, transcribed and thematically analysed.
Timepoint [2] 369575 0
Assessed at single point interview during ED visit (cross-sectional study)
Secondary outcome [3] 369628 0
Safety profile of advertised ED wait times as assessed by semi-structured interview with health administrator which will be recorded, transcribed and thematically analysed.
Timepoint [3] 369628 0
Assessed at single point interview during ED visit (cross-sectional study)
Secondary outcome [4] 369629 0
ED Wait times display preference of paramedics as assessed by study-specific interview which will be recorded, transcribed and thematically analysed.
Timepoint [4] 369629 0
Assessed at single point interview during ED visit (cross-sectional study)

Eligibility
Key inclusion criteria
• Convenience sample based on researcher availability, with purposive sampling of a variety of times and days of the week.
• Patients: Current emergency medicine patients waiting for care or waiting for completion of emergency medicine care (at facilities that have published wait times and those that don’t)
• Paramedics: Paramedics waiting to offload patients from ambulance stretchers to beds in emergency departments
• All patients (or their guardians/support persons) and paramedics who are potentially eligible for inclusion in the study will be invited to participate.
Minimum age
18 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
Yes
Key exclusion criteria
• Any patient/paramedic or community representative who does not consent
• Any patient deemed incapable of consent due to illness, capacity or communication barriers
• Any patient who exhibits significant distress
• Any patient whose treatment would be impeded or delayed by the interview (as judged by the patient, interviewer or clinical staff)
• Any paramedic who is required to attend to a patient rather than undertake the interview, based on patient needs (note 2 paramedics accompany a patient, usually one attends to the patient whilst the other is available to talk for short periods of time).

Study design
Purpose
Psychosocial
Duration
Cross-sectional
Selection
Convenience sample
Timing
Prospective
Statistical methods / analysis
Interviews will be held and recorded, usually at the bedside or in the waiting room (if applicable); no extra ED office space/interview rooms will be required. Each transcribed interview will be read and analysed.

All data will be analysed using grounded theory and axial coding using NVivo. Interviews will be continued and analysed until theme saturation achieved (3 consecutive interviews with no new theme introduction) for each demographic group.

Recruitment
Recruitment status
Recruiting
Date of first participant enrolment
Anticipated
13/05/2019
Actual
13/06/2019
Date of last participant enrolment
Anticipated
2/12/2019
Actual
Date of last data collection
Anticipated
2/12/2019
Actual
Sample size
Target
50
Accrual to date
30
Final
Recruitment in Australia
Recruitment state(s)
VIC
Recruitment hospital [1] 13612 0
Cabrini Hospital - Malvern - Malvern
Recruitment hospital [2] 13613 0
Monash Medical Centre - Clayton campus - Clayton
Recruitment hospital [3] 13614 0
Box Hill Hospital - Box Hill
Recruitment hospital [4] 13615 0
St Vincent's Hospital (Melbourne) Ltd - Fitzroy
Recruitment postcode(s) [1] 26274 0
3144 - Malvern
Recruitment postcode(s) [2] 26275 0
3168 - Clayton
Recruitment postcode(s) [3] 26276 0
3128 - Box Hill
Recruitment postcode(s) [4] 26277 0
3065 - Fitzroy

Funding & Sponsors
Funding source category [1] 302479 0
Charities/Societies/Foundations
Name [1] 302479 0
Cabrini Foundation
Country [1] 302479 0
Australia
Funding source category [2] 302511 0
Hospital
Name [2] 302511 0
Cabrini Institute
Country [2] 302511 0
Australia
Primary sponsor type
Individual
Name
Dr Michael Ben-Meir
Address
Emergency Department
Cabrini Hospital
181 Wattletree Rd,
Malvern 3144
VIC
Country
Australia
Secondary sponsor category [1] 302377 0
Individual
Name [1] 302377 0
A/Prof Katie Walker
Address [1] 302377 0
Emergency Department
Cabrini Hospital
181 Wattletree Rd,
Malvern 3144
VIC
Country [1] 302377 0
Australia
Other collaborator category [1] 280633 0
Individual
Name [1] 280633 0
Dr Melanie Stephenson
Address [1] 280633 0
Emergency Department
Cabrini
181 Wattletree Rd
Malvern 3144
VIC
Country [1] 280633 0
Australia
Other collaborator category [2] 280634 0
Individual
Name [2] 280634 0
A/Prof Keith Joe
Address [2] 280634 0
Emergency Department
Cabrini
181 Wattletree Rd
Malvern 3144
VIC
Country [2] 280634 0
Australia
Other collaborator category [3] 280635 0
Individual
Name [3] 280635 0
Prof Judy Lowthian
Address [3] 280635 0
Bolton Clarke
973 Nepean Highway
Bentleigh VIC 3204
Country [3] 280635 0
Australia
Other collaborator category [4] 280636 0
Individual
Name [4] 280636 0
Dr Amber Mills
Address [4] 280636 0
Bolton Clarke
973 Nepean Highway
Bentleigh VIC 3204
Country [4] 280636 0
Australia
Other collaborator category [5] 280637 0
Individual
Name [5] 280637 0
Dr David Rankin
Address [5] 280637 0
Cabrini Hospital
181 Wattletree Rd
Malvern 3144
VIC
Country [5] 280637 0
Australia
Other collaborator category [6] 280638 0
Individual
Name [6] 280638 0
Dr Gabriel Blecher
Address [6] 280638 0
Monash Medical Centre
246 Clayton Road
Clayton VIC 3168
Country [6] 280638 0
Australia
Other collaborator category [7] 280639 0
Individual
Name [7] 280639 0
Dr Rachel Rosler
Address [7] 280639 0
Monash Medical Centre
246 Clayton Road
Clayton VIC 3168
Country [7] 280639 0
Australia
Other collaborator category [8] 280640 0
Individual
Name [8] 280640 0
Dr Paul Buntine
Address [8] 280640 0
Eastern Health
8 Arnold St,
Box Hill VIC 3128
Country [8] 280640 0
Australia
Other collaborator category [9] 280641 0
Individual
Name [9] 280641 0
Dr Hamish Rodda
Address [9] 280641 0
Eastern Health
8 Arnold St,
Box Hill VIC 3128
Country [9] 280641 0
Australia
Other collaborator category [10] 280642 0
Individual
Name [10] 280642 0
Dr Kim Hansen
Address [10] 280642 0
St Andrew's War Memorial Hospital
457 Wickham Terrace,
Brisbane QLD 4000
Country [10] 280642 0
Australia
Other collaborator category [11] 280643 0
Individual
Name [11] 280643 0
A/Prof Michael Stephenson
Address [11] 280643 0
Ambulance Victoria
375 Manningham Rd
Doncaster VIC 3108
Country [11] 280643 0
Australia
Other collaborator category [12] 280644 0
Individual
Name [12] 280644 0
Dr Jennie Hutton
Address [12] 280644 0
St Vincent's Hospital
41 Victoria Parade
Fitzroy VIC 3065
Country [12] 280644 0
Australia
Other collaborator category [13] 280645 0
Individual
Name [13] 280645 0
Ella Martini
Address [13] 280645 0
C/- Cabrini Hospital
181 Wattletree Rd
Malvern VIC 3144
Country [13] 280645 0
Australia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 303141 0
Monash Health Human Research Ethics Committee
Ethics committee address [1] 303141 0
246 Clayton Rd
Clayton 3168
Victoria
Ethics committee country [1] 303141 0
Australia
Date submitted for ethics approval [1] 303141 0
29/04/2019
Approval date [1] 303141 0
Ethics approval number [1] 303141 0
Ethics committee name [2] 303167 0
Cabrini Human Research Ethics Committee
Ethics committee address [2] 303167 0
Cabrini Institute
154 Wattletree Rd
Malvern
Victoria
3144
Ethics committee country [2] 303167 0
Australia
Date submitted for ethics approval [2] 303167 0
11/04/2019
Approval date [2] 303167 0
27/05/2019
Ethics approval number [2] 303167 0

Summary
Brief summary
The decision to seek out emergency medical care is complex and nuanced. Many factors influence what care to seek and when. Once a facility or provider is chosen, there will be expectations for care competency and timeliness. Acutely unwell or distressed patients hope to see a Health Clinician or Doctor immediately on arrival, however this is rarely achievable. The reality for most patients is that they join a queue for care and wait to be treated. Previously, community health providers and patients have been blinded to the length of those queues.
In the era of expanding Information Technology (IT) capabilities, advertised Emergency Department (ED) wait times (real-time, available on the internet) have recently been posted in Australia, including Cabrini ED’s time to see a doctor. There is a paucity of information regarding the impact of this on patients, paramedics and community members.
The goal of the study is to explore the potential impact of advertised ED wait times by interviewing consumers and potential consumers of this information. Through this exploration, we hope to provide insight into the positive and negative aspects of this tool, allowing health administrators to determine whether and how to deploy the information.
This study will be a prospective, multicentre, qualitative study collecting data via semi-structured interviews with patients (or guardians), paramedics and community members. It will be conducted over 3 months at Cabrini Hospital, Monash Medical Centre and Box Hill emergency departments. Community members (Bolton-Clarke consumers, sports club members and community representatives) will be interviewed either face to face or via telephone. The interviews will be recorded and transcribed.
All data will be analysed and a descriptive paper submitted to various biomedical journals. This study aims to explore the impact of advertised ED wait times which may influence future policy decisions, the structure and deployment of wait time information and ongoing wait time and IT metadata application research.

Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 92614 0
A/Prof Katie Walker
Address 92614 0
Cabrini Hosptital
181 Wattletree Rd
Malvern 3144
VIC
Country 92614 0
Australia
Phone 92614 0
+61 3 95081500
Fax 92614 0
Email 92614 0
[email protected]
Contact person for public queries
Name 92615 0
Dr Melanie Stephenson
Address 92615 0
Cabrini Hospital
181 Wattletree Rd
Malvern 3144
VIC
Country 92615 0
Australia
Phone 92615 0
+61 3 95081500
Fax 92615 0
Email 92615 0
[email protected]
Contact person for scientific queries
Name 92616 0
A/Prof Katie Walker
Address 92616 0
Cabrini Hospital
181 Wattletree Rd
Malvern 3144
VIC
Country 92616 0
Australia
Phone 92616 0
+61 3 95081500
Fax 92616 0
Email 92616 0
[email protected]

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
No/undecided IPD sharing reason/comment
Privacy of participants will be protected and it is likely that transcripts of interviews will not be available to future researchers to ensure this protection.


What supporting documents are/will be available?

Doc. No.TypeCitationLinkEmailOther DetailsAttachment
1856Informed consent form    377389-(Uploaded-23-04-2019-13-28-00)-Study-related document.docx
1927Study protocol    377389-(Uploaded-23-04-2019-13-28-46)-Study-related document.docx



Results publications and other study-related documents

Documents added manually
No documents have been uploaded by study researchers.

Documents added automatically
No additional documents have been identified.