Factors Influencing SurgeCon Implementation in Four Canadian Emergency Departments Guided by Consolidated Framework for Implementation Research

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BACKGROUND: Emergency department (ED) overcrowding remains a significant national issue in Canada. To address this issue, SurgeCon, a quality improvement program, was implemented to enhance patient flow, improve communication, and reduce wait times. Despite their potential, interventions like SurgeCon lack evidence on real-world implementation and sustainability in high-pressure, resource-limited ED settings. OBJECTIVE: This study explores the factors influencing the implementation of SurgeCon in four Canadian EDs using the Consolidated Framework for Implementation Research (CFIR) to identify facilitators and barriers. METHODS: Data were collected over 2.5 years-before, during, and after SurgeCon implementation-in two rural and two urban EDs in Canada using a longitudinal qualitative research (LQR) design. Forty-two semi-structured interviews with physicians, nurses, and hospital managers were analyzed through inductive and deductive thematic analysis, guided by the CFIR framework. RESULTS: Facilitators were predominantly associated with CFIR's Innovation Characteristics, particularly the perceived benefits of real-time data collection, workflow optimization, and enhanced communication. However, barriers-mainly linked to outer setting (COVID-19 disruptions), inner setting (resource constraints and fragmented communication), and individual characteristics (leadership engagement and motivation)-outweighed these advantages. CONCLUSION: To strengthen adoption, this study proposes eight strategic action plans focusing on leadership commitment, automation, cross-departmental collaboration, feedback loops and change management strategies to maximize facilitators and address implementation barriers. TRIAL REGISTRATION: ClinicalTrials.gov. NCT04789902. 10/03/2021.

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