Estimating Key Performance Indicators of a New Emergency Department Model

2020 ◽  
pp. 580-598 ◽  
Author(s):  
Soraia Oueida ◽  
Seifedine Kadry ◽  
Sorin Ionescu
Keyword(s):  
Emergency Department ◽  
Resource Allocation ◽  
Length Of Stay ◽  
Patient Flow ◽  
Real Life ◽  
Optimal Solution ◽  
Real System ◽  
Medical Facility ◽  
The Real ◽  
Customer Dissatisfaction

In this article, a real-life Emergency Department (ED) is studied and analyzed in order to propose areas for improvement in its operations and patient flow. EDs are in native very busy and complex systems where medical facility treatments are provided to arriving patients without any prior appointment. ED, a 24/7 open facility, interacts with the majority of other departments of the healthcare system. Due to this complexity and unplanned nature of patient surge, simulation modeling is proven to be very effective in order to study the necessary changes needed for better performance. As a consequence of these challenges, the patient LoS (Length of Stay) and the human-resource utilization rates are increased and thus leading to staff and customer dissatisfaction which need to be addressed for better performance. An emergency department of a hospital in Lebanon is chosen for simulation using Arena software where a model is designed to match the real system. This model is then verified, validated and enhanced by proposing some modifications in the resource allocation levels. These improvements are achieved by running different scenarios using Arena Process Analyzer and suggesting an optimal solution using Arena OptQuest tool without the need of interrupting the real system.

Estimating Key Performance Indicators of a New Emergency Department Model

2017 ◽  
Vol 7 (2) ◽  
pp. 1-16 ◽  
Author(s):  
Soraia Oueida ◽  
Seifedine Kadry ◽  
Sorin Ionescu
Keyword(s):  
Emergency Department ◽  
Performance Indicators ◽  
Simulation Modeling ◽  
Patient Flow ◽  
Real Life ◽  
Optimal Solution ◽  
Real System ◽  
Medical Facility ◽  
The Real ◽  
Customer Dissatisfaction

In this article, a real-life Emergency Department (ED) is studied and analyzed in order to propose areas for improvement in its operations and patient flow. EDs are in native very busy and complex systems where medical facility treatments are provided to arriving patients without any prior appointment. ED, a 24/7 open facility, interacts with the majority of other departments of the healthcare system. Due to this complexity and unplanned nature of patient surge, simulation modeling is proven to be very effective in order to study the necessary changes needed for better performance. As a consequence of these challenges, the patient LoS (Length of Stay) and the human-resource utilization rates are increased and thus leading to staff and customer dissatisfaction which need to be addressed for better performance. An emergency department of a hospital in Lebanon is chosen for simulation using Arena software where a model is designed to match the real system. This model is then verified, validated and enhanced by proposing some modifications in the resource allocation levels. These improvements are achieved by running different scenarios using Arena Process Analyzer and suggesting an optimal solution using Arena OptQuest tool without the need of interrupting the real system.

scholarly journals The Sydney triage to admission risk tool (START) to improve patient flow in an emergency department: a model of care implementation pilot study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Anja Ebker-White ◽  
Kendall J. Bein ◽  
Saartje Berendsen Russell ◽  
Michael M. Dinh
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
Intervention Group ◽  
Control Sample ◽  
Patient Admission ◽  
Implementation Study ◽  
Model Of Care ◽  
Early Assessment ◽  
Pilot Implementation

Abstract Background The Sydney Triage to Admission Risk Tool (START) is a validated clinical analytics tool designed to estimate the probability of in-patient admission based on Emergency Department triage characteristics. Methods This was a single centre pilot implementation study using a matched case control sample of patients assessed at ED triage. Patients in the intervention group were identified at triage by the START tool as likely requiring in-patient admission and briefly assessed by an ED Consultant. Bed management were notified of these patients and their likely admitting team based on senior early assessment. Matched controls were identified on the same day of presentation if they were admitted to the same in-patient teams as patients in the intervention group and same START score category. Outcomes were ED length of stay and proportion of patients correctly classified as an in-patient admission by the START tool. Results One hundred and thirteen patients were assessed using the START-based model of care. When compared with matched control patients, this intervention model of care was associated with a significant reduction in ED length of stay [301 min (IQR 225–397) versus 423 min (IQR 297–587) p < 0.001] and proportion of patients meeting 4 h length of stay thresholds increased from 24 to 45% (p < 0.001). Conclusion In this small pilot implementation study, the START tool, when used in conjunction with senior early assessment was associated with a reduction in ED length of stay. Further controlled studies are now underway to further examine its utility across other ED settings.

scholarly journals Emergency Department Patient Flow: The Influence of Hospital Census Variables on Emergency Department Length of Stay

2009 ◽  
Vol 16 (7) ◽  
pp. 597-602 ◽  
Author(s):  
Ray Lucas ◽  
Heather Farley ◽  
Joseph Twanmoh ◽  
Andrej Urumov ◽  
Nils Olsen ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
Emergency Department Patient

scholarly journals Specialized fast track: a sustainable model to improve emergency department patient flow

2015 ◽  
Vol 4 (5) ◽  
pp. 40
Author(s):  
Emilpaolo Manno ◽  
Marco Pesce ◽  
Umberto Stralla ◽  
Federico Festa ◽  
Silvio Geninatti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Fast Track ◽  
Patient Flow ◽  
Wait Time ◽  
Emergency Department Patient ◽  
Care Needs ◽  
Time Length ◽  
Hospital Units ◽  
Ed Visits

Objective: Emergency department (ED) overcrowding is a hospital-wide problem that demands a whole-hospital solution. We developed and implemented a fast track model for streaming ED patients with low-acuity illness or injury to specialized care areas (gynecology-obstetrics, orthopedics-trauma, pediatrics, and primary care) staffed by existing specialist resources with access to general ED services. The study aim was to determine whether streaming of ED visits into specialized fast track areas increased operational efficiency and improved patient flow in a mixed adult and pediatric ED without incurring extra costs.Methods: We retrospectively reviewed the ED discharge records of patients who were mainstreamed or fast tracked during the 3-year period from 1 January 2010 through 31 December 2012. ED visits were identified according to a five-level triage scheme; performance indicators were compared for: wait time, length of stay, leave before being seen and revisit rates.Results: A reduction in wait time, length of stay, and leave before being seen rate was seen with fast track streaming (p < .01). These improvements were achieved without additional medical and nurse staffing.Conclusions: Specialized fast track streaming helped us meet patients’ care needs and contain costs. Lower-acuity patients were seen quickly by a specialist and safely discharged or admitted to the hospital without diverting resources from patients with high-acuity illness or injury. Involvement of all stakeholders in seeking a sustainable solution to ED crowding as a hospital-wide problem was key to enhancing cooperation between the ED and the hospital units.

scholarly journals A novel similarity measure for mining missing links in long-path networks

2021 ◽  
Author(s):  
Yijun Ran ◽  
Tianyu Liu ◽  
Tao Jia ◽  
Xiao-Ke Xu
Keyword(s):  
Link Prediction ◽  
Real Life ◽  
Structural Evolution ◽  
Poor Performance ◽  
Real System ◽  
Machine Learning Techniques ◽  
Information Mining ◽  
The Real ◽  
Network Information ◽  
Maximal Information Coefficient

Abstract Network information mining is the study of the network topology, which may answer a large number of application-based questions towards the structural evolution and the function of a real system. The question can be related to how the real system evolves or how individuals interact with each other in social networks. Although the evolution of the real system may seem to be found regularly, capturing patterns on the whole process of evolution is not trivial. Link prediction is one of the most important technologies in network information mining, which can help us understand the evolution mechanism of real-life network. Link prediction aims to uncover missing links or quantify the likelihood of the emergence of nonexistent links from known network structures. Currently, widely existing methods of link prediction almost focus on short-path networks that usually have a myriad of close triangular structures. However, these algorithms on highly sparse or long-path networks have poor performance. Here, we propose a new index that is associated with the principles of Structural Equivalence and Shortest Path Length (SESPL) to estimate the likelihood of link existence in long-path networks. Through 548 real networks test, we find that SESPL is more effective and efficient than other similarity-based predictors in long-path networks. Meanwhile, we also exploit the performance of SESPL predictor and of embedding-based approaches via machine learning techniques. The results show that the performance of SESPL can achieve a gain of 44.09% over GraphWave and 7.93% over Node2vec. Finally, according to the matrix of Maximal Information Coefficient (MIC) between all the similarity-based predictors, SESPL is a new independent feature in the space of traditional similarity features.

scholarly journals Solving Real-Life Problem Using Transportation

2019 ◽  
Vol 8 (10) ◽  
pp. 4284-4287
Keyword(s):  
Real Life ◽  
Optimal Solution ◽  
Transportation Cost ◽  
Travel Agency ◽  
Optimum Level ◽  
Transportation Model ◽  
The Real ◽  
Maximum Profit ◽  
Maximum Value ◽  
Real Life Problem

Herewith a methodology is proposed towards obtaining optimum level as solution for the real-life problem using Transportation. This paper is composed for a travel agency company to get maximum profit and also to minimize the transportation cost. In the proposed method maximum value is marked both in row-wise and column-wise for maximization type and minimum valueis marked both in row-wise and column-wise for minimization type and the greatest maximum value is given allocation. Here a New algorithm is used to solve the transportation model to make maximum profit for the Company. This method gives the optimal solution in less iteration.

scholarly journals THE EFFECT OF A BOARDING RESTRICTION PROTOCOL ON EMERGENCY DEPARTMENT CROWDING

2021 ◽  
Author(s):  
Ji Hwan Lee ◽  
Ji Hoon Kim ◽  
Incheol Park ◽  
Hyun Sim Lee ◽  
Joon Min Park ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Primary Outcome ◽  
Treatment Time ◽  
Patient Flow ◽  
Hospital Beds ◽  
Before And After ◽  
Day Of The Week ◽  
Ed Crowding ◽  
Post Period

ABSTRACT Background Access block due to a lack of hospital beds causes emergency department (ED) crowding. We initiated the boarding restriction protocol that limits ED length of stay (LOS) for patients awaiting hospitalization to 24 hours from arrival. This study aimed to determine the effect of the protocol on ED crowding. Method This was a pre-post comparative study to compare ED crowding before and after protocol implementation. The primary outcome was the red stage fraction with more than 71 occupying patients in the ED (severe crowding level). LOS in the ED, treatment time and boarding time were compared. Additionally, the pattern of boarding patients staying in the ED according to the day of the week was confirmed. Results Analysis of the number of occupying patients in the ED, measured at 10-minute intervals, indicated a decrease from 65.0 (51.0-79.0) to 55.0 (43.0-65.0) in the pre- and post-periods, respectively (p<0.0001). The red stage fraction decreased from 38.9% to 15.1% of the pre- and post-periods, respectively (p<0.0001). The proportion beyond the goal of this protocol of 24 hours decreased from 7.6% to 4.0% (p<0.0001). The ED LOS of all patients was similar: 238.2 (134.0-465.2) and 238.3 (136.9-451.2) minutes in the pre- and post-periods, respectively. In admitted patients, ED LOS decreased from 770.7 (421.4-1587.1) to 630.2 (398.0-1156.8) minutes (p<0.0001); treatment time increased from 319.6 (198.5-482.8) to 344.7 (213.4-519.5) minutes (p<0.0001); and boarding time decreased from 298.9 (109.5-1149.0) to 204.1 (98.7-545.7) minutes (p<0.0001). In the pre-period, boarding patients accumulated in the ED on weekdays, with the accumulation resolved on Fridays; this pattern was alleviated in the post-period. Conclusions The protocol effectively resolved excessive ED crowding by alleviating the accumulation of boarding patients in the ED on weekdays. Additional studies should be conducted on changes this protocol brings to patient flow hospital-wide.

scholarly journals Length of stay as quality indicator in emergency departments: analysis of determinants in the German Emergency Department Data Registry (AKTIN registry)

2022 ◽  
Author(s):  
Ronny Otto ◽  
Sabine Blaschke ◽  
Wiebke Schirrmeister ◽  
Susanne Drynda ◽  
Felix Walcher ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Emergency Departments ◽  
Patient Flow ◽  
Management Strategies ◽  
Organizational Factors ◽  
Related Factors ◽  
Adult Age ◽  
Emergency Department Data ◽  
Data Registry

AbstractSeveral indicators reflect the quality of care within emergency departments (ED). The length of stay (LOS) of emergency patients represents one of the most important performance measures. Determinants of LOS have not yet been evaluated in large cohorts in Germany. This study analyzed the fixed and influenceable determinants of LOS by evaluating data from the German Emergency Department Data Registry (AKTIN registry). We performed a retrospective evaluation of all adult (age ≥ 18 years) ED patients enrolled in the AKTIN registry for the year 2019. Primary outcome was LOS for the whole cohort; secondary outcomes included LOS stratified by (1) patient-related, (2) organizational-related and (3) structure-related factors. Overall, 304,606 patients from 12 EDs were included. Average LOS for all patients was 3 h 28 min (95% CI 3 h 27 min–3 h 29 min). Regardless of other variables, patients admitted to hospital stayed 64 min longer than non-admitted patients. LOS increased with patients’ age, was shorter for walk-in patients compared to medical referral, and longer for non-trauma presenting complaints. Relevant differences were also found for acuity level, day of the week, and emergency care levels. We identified different factors influencing the duration of LOS in the ED. Total LOS was dependent on patient-related factors (age), disease-related factors (presentation complaint and triage level), and organizational factors (weekday and admitted/non-admitted status). These findings are important for the development of management strategies to optimize patient flow through the ED and thus to prevent overcrowding.

scholarly journals The association between the transfer of emergency department admitted patients to inpatient hallways and outcomes of oncology patients

2015 ◽  
Vol 4 (2) ◽  
pp. 1 ◽  
Author(s):  
Charles Lim ◽  
Matthew C. Cheung ◽  
Maureen E. Trudeau ◽  
Kevin R. Imrie ◽  
Ben De Mendonca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
Vital Signs ◽  
Medication Administration ◽  
Oncology Patients ◽  
Flow Quality ◽  
Ed Crowding ◽  
The Impact

Objective: A protocol was implemented to ease Emergency Department (ED) crowding by moving suitable admitted patients into inpatient hallway beds (HALL) or off-service beds (OFF) when beds on an admitting service’s designated ward (ON) were not available. This study assessed the impact of hallway and off-service oncology admissions on ED patient flow, quality of care and patient satisfaction.Methods: Retrospective and prospective data were collected on patients admitted to the medical oncology service from Jan 1 to Dec 31, 2011. Data on clinician assessments and time performance measures were collected. Satisfaction surveys were prospectively administered to all patients. Results: Two hundred and ninty-seven patients (117 HALL, 90 OFF, 90 ON) were included in this study. There were no significant differences between groups for frequency of physician assessments, physical exam maneuvers at initial physician visit, time to complete vital signs or time to medication administration. The median (IQR) time spent admitted in the ED prior to departure from the ED was significantly longer for HALL patients (5.53 hrs [1.59-13.03 hrs]) compared to OFF patients (2.00 hrs [0.37-3.69 hrs]) and ON patients (2.18 hrs [0.15-5.57 hrs]) (p < .01). Similarly, the median (IQR) total ED length of stay was significantly longer for HALL patients (13.82 hrs [7.43-20.72 hrs]) compared to OFF patients (7.18 hrs [5.72-11.42 hrs]) and ON patients (9.34 hrs [5.43-14.06 hrs]) (p < .01). HALL patients gave significantly lower overall satisfaction scores with mean (SD) satisfaction scores for HALL, OFF and ON patients being 3.58 (1.20), 4.23 (0.58) and 4.29 (0.69) respectively (p < .01). Among HALL patients, 58% were not comfortable being transferred into the hallway and 4% discharged themselves against medical advice. Conclusions: The protocol for transferring ED admitted patients to inpatient hallway beds did not reduce ED length of stay for oncology patients. The timeliness and frequency of clinical assessments were not compromised; however, patient satisfaction was decreased.

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