iREDUCE Implementation Research in Emergency Departments to reduce Unhelpful Care and ensure Excellence: A National Prioritising Process to Reduce Unhelpful Emergency Care.

Health research prioritisation is a process where experts and stakeholders identify key areas requiring knowledge generation within a field. Identifying and guiding health research to priority areas allows for fairer distribution of limited resources where the greatest societal benefits are obtained.(35) Previous research and unhelpful care prioritising processes in Emergency Care have lacked rigorous methodology, been siloed, nonspecific, outdated or limited to paediatric care.(14, 36-38) The Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network has provided an international benchmark in research priorities and implementation in paediatric emergency care to reduce unhelpful care and aim for excellence. The network was originally funded by the NHMRC CRE program in 2015 and has received ongoing financial and in-kind support since. It is an exemplar in evidence generation and implementation. Our process will be limited to adult emergency care to avoid duplication with the PREDICT network and CRE. A modified Delphi approach will be used to identify a list of national priorities to reduce unhelpful emergency care. for the next decade.(39) The subsequent Hanlon method will inform the selection of the top target areas, or processes of care, based upon feasibility and impact.(40) This method allows more weight to be placed on defined areas and thus can assist in setting priorities relevant to the context of the prioritisation exercise.(41) Methodology Study population and sample Steering Group: Will be a subgroup of the iREDUCE Steering Group and include consumers. Participants: individuals invited to participate in the creation and narrowing of emergency care priorities will include ED doctors, nurses, pharmacists, physiotherapists, other allied health, researchers, hospital administrative staff, hospital directors, and consumer advisors. All individuals who volunteer to participate will be employees or consumers of health organisations participating in the study. Individuals can voluntarily participate after receiving an invitation via email. There will be no restrictions on the number of participants or level of emergency care experience to be eligible to participate. Step 1 – Initial Priority List: An extensive list of initial priorities will be set by the Steering Group. Members will be asked to determine their top priorities considering their emergency care research, experience, and clinical knowledge. Members will then attend a virtual meeting to reach a consensus on the top priorities. The initial number of priorities will be determined by the Steering Group. Step – Narrowing of Priorities: Participants will be sent an email link to the online survey platform Qualtrics, with the opportunity to anonymously provide demographic information, rank the priorities set by the Steering Group and add additional priorities. Questions regarding demographic information will include age, gender, job title, years of clinical experience, involvement in research, hospital where they are employed or volunteer (i.e., rural, regional, suburban, or metro), and highest degree achieved. They will be able to respond to the initial set of priorities established by the Steering Group using a 7-point Likert scale. Topics rated moderately important, very important and extremely important by ≥70% of respondents will continue onto the subsequent survey. furthermore, participants can also respond to the following question, “Thinking about processes and procedures in the emergency department, what are the most important areas requiring change to reduce unhelpful emergency care?’ All newly proposed areas will continue to Step 3. Consent will be implied by a participant’s response to the survey. The Steering Group will oversee but not participate in this stage. Step 3 – Hanlon Method: The Hanlon process(42) will be applied to highly ranked priorities and all new PICO clinical research questions(43) or free text priorities submitted by participants. The Steering Group will utilise the Hanlon process through an online survey allowing for weight to be applied to the prevalence, seriousness, and feasibility of a priority. A score will be calculated for each of the domains, then combined to give a mean score. This will result in a final list of ranked priorities. Outcomes: a comprehensive, specific set of national priorities for reducing unhelpful emergency care 202