Description

The main objectives of the study are to 1) to describe, and evaluate the feasibility and acceptability of a novel ED PSW program implemented by the Vancouver Coastal Health at the Vancouver General Hospital (VGH) ED, 2) to evaluate the feasibility of creating a randomized shift schedule in support of a future definitive randomized controlled trial, 3) to validate outcomes related to patients leaving before completing care using administrative data from the National Ambulatory Care Reporting System (NACRS), and 4) to obtain preliminary estimates of incidence of patients who leave the ED before completing care, to inform sample size calculations for a definitive randomized controlled trial.

The study will take place at Vancouver General Hospital (VGH), a large ED with approximately 97,000 visits per year, serving a diverse urban population. Investigators will evaluate our randomized shift schedule generation, and will describe our intervention and patient population through data within our PSW interaction logs and linkages to regional data. To understand our intervention and patient and provider experiences, investigators will use a mixed methods design to comprehensively collect, analyze, and interpret both qualitative and quantitative data. This approach will provide insights from multiple perspectives, offering a robust understanding of the relationships and potential contradictions within the evidence, thereby enriching the data and deepening our understanding of the findings.

Investigators will evaluate feasibility and acceptability of the PSW program at engaging patients with specific demographic, health history, and risk profiles. Investigators will assess the degree to which patients of different backgrounds access and engage with PSW services, and what characteristics affect patient acceptance of PSW services offered. Investigators will then work with the ED leadership team to target and tailor the program to best meet the needs of patients at highest risk.

This feasibility study will set the foundation for a definitive randomized controlled trial, which will be the first to compare patients with substance use who leave EDs before completing care during shifts with PSW availability versus without, addressing a critical knowledge gap. The definitive trial will engage multiple sites across Canada to rigorously evaluate ED PSW effectiveness, with the potential to scale up an intervention that could improve patient outcomes on a national scale.