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Background Despite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Development countries. From a patient’s perspective, this challenge has been described as “patients wait in pain or discomfort for hours before being seen at EDs.” To overcome the challenge of increased wait times, we developed an innovative ED management platform called SurgeCon that was designed based on continuous quality improvement principles to maintain patient flow and mitigate the impact of patient surge on ED efficiency. The SurgeCon quality improvement intervention includes a protocol-driven software platform, restructures ED organization and workflow, and aims to establish a more patient-centric environment. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador, and found that there was a 32% reduction in ED wait times. Objective The primary objective of this trial is to determine the effects of SurgeCon on ED performance by assessing its impact on length of stay, the time to a physician’s initial assessment, and the number of patients leaving the ED without being seen by a physician. The secondary objectives of this study are to evaluate SurgeCon’s effects on patient satisfaction and patient-reported experiences with ED wait times and its ability to create better-value care by reducing the per-patient cost of delivering ED services. Methods The implementation of the intervention will be assessed using a comparative effectiveness-implementation hybrid design. This type of hybrid design is known to shorten the amount of time associated with transitioning interventions from being the focus of research to being used for practice and health care services. All EDs with 24/7 on-site physician support (category A hospitals) will be enrolled in a 31-month, pragmatic, stepped wedge cluster randomized trial. All clusters (hospitals) will start with a baseline period of usual care and will be randomized to determine the order and timing of transitioning to intervention care until all hospitals are using the intervention to manage and operationalize their EDs. Results Data collection for this study is continuing. As of February 2022, a total of 570 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. The first of the 4 EDs was randomly selected, and it is currently using SurgeCon’s eHealth platform and applying efficiency principles that have been learned through training since September 2021. The second randomly selected site will begin intervention implementation in winter 2022. Conclusions By assessing the impact of SurgeCon on ED services, we hope to be able to improve wait times and create better-value ED care in this health care context. Trial Registration ClinicalTrials.gov NCT04789902; https://clinicaltrials.gov/ct2/show/NCT04789902 International Registered Report Identifier (IRRID) DERR1-10.2196/30454

This article aims to bridge the gap in our knowledge about Iranian prisons and the sociodynamic relations that animate them by illuminating the characteristics and activities of prison gangs in Iran. The interaction between gang affiliation and drug networks, security and violence will be discussed in detail. The in-depth qualitative research, which is informed by grounded theory, serves as the first academic study of gangs in Iranian prisons. Research participants included 38 males and 52 females aged 10–65 years. They were recruited in several different settings, both governmental and non-governmental organizations. The study employed theoretical sampling and in-depth, semi-structured interviewing. Results show that gang-affiliated inmates in Iranian prisons gain monopoly over the drugs market inside prison networks, which leads to inevitable extortion of both prisoners and correctional officers. Gang affiliation blurs the lines between violence and safety, while providing a sense of identity, belonging and financial and emotional support. Prison gang membership also offers some benefits to prisoners and staff, as their existence underpins an informal social order that can be used to govern prisoners. The article discusses this less well-known and unexplored dimension of the topic.