A Monte Carlo Simulation Algorithm to Assess Rollout Feasibility in Stepped-Wedge Trials: A Case Study of National CPR Training Kiosk Deployment

Background: Stepped-wedge cluster randomized trials (SW-CRTs) are increasingly used to evaluate population-level interventions, but trial validity depends on timely cluster transitions. Rollout feasibility is often assumed rather than modelled. In the context of a planned national trial of CPR training kiosks, we developed a Monte Carlo simulation algorithm to quantify logistical feasibility under uncertainty. Methods: A stochastic Monte Carlo algorithm was implemented to simulate deploying 100 CPR kiosks across eight Canadian cities under four team structures. Inputs included productivity (0.8–1.2 kiosks/day), disruption probabilities (weather, venue access, technical failure, staff illness, transport delays), and cost parameters (salaries, per diems, travel). Each scenario was simulated across 3000 iterations. Outputs included per-city feasibility (p ≤ 60 days), total project duration, and risk–cost trade-offs. Results: Single-team strategies required 9–10 months for full rollout, with winter-exposed cities such as Halifax and Charlottetown having up to 30% probability of exceeding 60 days. Two-team strategies halved rollout time (4–5 months) and achieved >95% on-time rollout across cities. Adding a third onsite staff member reduced risk by 5–15% with modest additional cost (~CAD 1500–2000 per city). Risk–cost analysis identified two teams with three staff as the most reliable strategy. Conclusions: Monte Carlo simulation provides a practical framework for assessing rollout feasibility in SW-CRTs. Applied to CPR kiosk deployment, it highlights the importance of staffing, seasonality, and city-level context. The approach is generalizable to other national interventions requiring phased rollout under uncertainty.