scholarly journals A modular simulation study to improve patient flow to inpatient units in the emergency department

2014 ◽  
Vol 3 (6) ◽  
pp. 205 ◽  
Author(s):  
Shaghayegh Norouzzadeh ◽  
Joseph Garber ◽  
Melonie Longacre ◽  
Salaahuddin Akbar ◽  
Nancy Riebling ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cycle Time ◽  
Patient Flow ◽  
Discrete Event ◽  
Wait Time ◽  
Process Improvements ◽  
Ed Overcrowding ◽  
Current Resource ◽  
Inpatient Units ◽  
Modular Simulation

In this study, a modular discrete event simulation (computer modeling) has been presented to support process improvements in a hospital’s emergency department (ED) to streamline admitted patient flow to inpatient units. Because the ED in this study has less than 10 beds, unnecessary occupation of beds affects the patient wait time dramatically. Additionally, ED overcrowding diminishes the quality of care, increases costs, and decreases employee and patient satisfaction. The modular simulation model evaluated the effectiveness of several recommended workflow improvements, resulting from comprehensive statistical analysis, based on their impact on cycle time and time traps in the process. The results suggested that, to ensure better efficiency and optimal cycle time, all of the suggested workflow improvements should be implemented simultaneously. The model also suggested that achieving customer satisfaction is possible 96.26% of the time with the current resource allocations in the ED.

scholarly journals Patient Flow Simulation Using Historically Informed Synthetic Data

2021 ◽  
Author(s):  
Ezra Kenny ◽  
Hamed Hassanzadeh ◽  
Sankalp Khanna ◽  
Justin Boyle ◽  
Sandra Louise
Keyword(s):  
Emergency Department ◽  
Simulation Model ◽  
Patient Flow ◽  
Discrete Event ◽  
Synthetic Data ◽  
Flow Simulation ◽  
Average Patient ◽  
Future Demands ◽  
Healthcare Administrators ◽  
Using Data

Hospital overcrowding is a major problem for healthcare systems around the globe. In order to better estimate future demands and adequate resources for coping with such demands, statistical and computerised modelling can be applied. This can then allow healthcare administrators and decision makers to quantify the impacts of various “what-if” scenarios on hospital performance measures. This paper investigates the application of Discrete Event Simulation towards optimising Emergency Department resources while measuring overall length of stay and queuing time of emergency patients as a target performance measure. In particular, we explore strategies for generating historically informed synthetic data that helps the simulation model track patient flow through the target hospital over a future time frame. Using the developed simulation model, several resource configurations are tested using data from one of the busiest emergency departments in the state of Queensland as the baseline while quantifying the impacts of such changes on key patient flow metrics. It was found that adding a single bed (and associated resources) to the emergency department would result in a 23% decrease in average patient treatment delay.

Bottleneck detection for improvement of Emergency Department efficiency

2015 ◽  
Vol 21 (3) ◽  
pp. 564-585 ◽  
Author(s):  
Yuancheng Zhao ◽  
Qingjin Peng ◽  
Trevor Strome ◽  
Erin Weldon ◽  
Michael Zhang ◽  
...  
Keyword(s):  
Emergency Department ◽  
Simulation Modeling ◽  
Treatment Time ◽  
Patient Flow ◽  
Current Model ◽  
Public Healthcare ◽  
Time Saving ◽  
Content Type ◽  
Bottleneck Detection ◽  
Ed Overcrowding

Purpose – The purpose of this paper is to introduce a method of the bottleneck detection for Emergency Department (ED) improvement using benchmarking and design of experiments (DOE) in simulation model. Design/methodology/approach – Four procedures of treatments are used to represent ED activities of the patient flow. Simulation modeling is applied as a cost-effective tool to analyze the ED operation. Benchmarking provides the achievable goal for the improvement. DOE speeds up the process of bottleneck search. Findings – It is identified that the long waiting time is accumulated by previous arrival patients waiting for treatment in the ED. Comparing the processing time of each treatment procedure with the benchmark reveals that increasing the treatment time mainly happens in treatment in progress and emergency room holding (ERH) procedures. It also indicates that the to be admitted time caused by the transfer delay is a common case. Research limitations/implications – The current research is conducted in the ED only. Activities in the ERH require a close cooperation of several medical teams to complete patients’ condition evaluations. The current model may be extended to the related medical units to improve the model detail. Practical implications – ED overcrowding is an increasingly significant public healthcare problem. Bottlenecks that affect ED overcrowding have to be detected to improve the patient flow. Originality/value – Integration of benchmarking and DOE in simulation modeling proposed in this research shows the promise in time-saving for bottleneck detection of ED operations.

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 The impact of computerized provider order entry on emergency department flow

CJEM ◽  
2016 ◽  
Vol 18 (4) ◽  
pp. 264-269 ◽  
Author(s):  
Andrew Gray ◽  
Christopher M.B. Fernandes ◽  
Kristine Van Aarsen ◽  
Melanie Columbus
Keyword(s):  
Emergency Department ◽  
Patient Safety ◽  
Improve Patient Safety ◽  
Patient Flow ◽  
Wait Time ◽  
Order Entry ◽  
Computerized Provider Order Entry ◽  
Left Without Being Seen ◽  
Before And After ◽  
The Impact

AbstractObjectivesComputerized provider order entry (CPOE) has been established as a method to improve patient safety by avoiding medication errors; however, its effect on emergency department (ED) flow remains undefined. We examined the impact of CPOE implementation on three measures of ED throughput: wait time (WT), length of stay (LOS), and the proportion of patients that left without being seen (LWBS).MethodsWe conducted a retrospective cohort study of all ED patients of 18 years and older presenting to London Health Sciences Centre during July and August 2013 and 2014, before and after implementation of a CPOE system. The three primary variables were compared between time periods. Subgroup analyses were also conducted within each Canadian Triage and Acuity Scale (CTAS) level (1–5) individually, as well as for admitted patients only.ResultsA significant increase in WT of 5 minutes (p=0.036) and LOS of 10 minutes (p=0.001), and an increase in LWBS from 7.2% to 8.1% (p=0.002) was seen after CPOE implementation. Admitted patients’ LOS increased by 63 minutes (p<0.001), the WT of CTAS 3 and 5 patients increased by 6 minutes (p=0.001) and 39 minutes (p=0.005), and LWBS proportion increased significantly for CTAS 3–5 patients, from 24.3% to 42.0% (p<0.001) for CTAS 5 patients specifically.ConclusionsCPOE implementation detrimentally impacted all patient flow throughput measures that we examined. The most striking clinically relevant result was the increase in LOS of 63 minutes for admitted patients. This raises the question as to whether the potential detrimental effects to patient safety of CPOE implementation outweigh its benefits.

Process Improvements to Reform Patient Flow in the Emergency Department

2016 ◽  
Vol 19 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Shawn Whatley ◽  
Alexander Leung ◽  
Marko Duic
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Process Improvements

scholarly journals Improving Emergency Department Throughput: Using a Pull Method of Patient Flow

2021 ◽  
Author(s):  
◽  
Jeffrey Collins
Keyword(s):  
Emergency Department ◽  
Delay Time ◽  
Medical Center ◽  
Patient Flow ◽  
Length Of Hospital Stay ◽  
Hand Off ◽  
Practice Problem ◽  
Inpatient Units ◽  
Push Model ◽  
Surgical Unit

Practice Problem: Overcrowding in the emergency department (ED) has been shown to increase the length of hospital stay, adversely impact patient outcomes, and reduce patient satisfaction. Problems with overcrowding and throughput are often thought of as an ED-specific inefficiency; however, the issue is indicative of hospital-wide inefficiencies. PICOT: The PICOT question that guided this project was “For ED patients admitted to the medical-surgical unit at an acute medical center, will the implementation of a pull model for patient flow, when compared to the current push model, reduce admission delay and length of stay (LOS) within six weeks of implementation? Evidence: A total of 21 studies were identified in the literature that directly support the implementation of this project. Themes from the literature include delays adversely impact patients, ED throughput is directly affected by throughput of inpatient units, and bed ahead programs can improve throughput. Intervention: The primary intervention for this project was implementing a bed ahead process for the host facility. The nurse hand-off process was also altered to improve efficiency. Outcome: The project resulted in an improvement in the ED delay time. During the project, the mean admission delay time was reduced from 184 minutes to 112 minutes. Conclusion: Using a pull methodology effectively enhances ED throughput by reducing delays in the ED admission process.

scholarly journals Impact of process improvements on measures of emergency department efficiency

CJEM ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 96-105 ◽  
Author(s):  
Alexander K. Leung ◽  
Shawn D. Whatley ◽  
Dechang Gao ◽  
Marko Duic
Keyword(s):  
Emergency Department ◽  
Patient Flow ◽  
Interrupted Time Series ◽  
Initial Assessment ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Process Improvements ◽  
Left Without Being Seen ◽  
Clinically Significant ◽  
The Impact

AbstractObjectiveTo study the operational impact of process improvements on emergency department (ED) patient flow. The changes did not require any increase in resources or expenditures.MethodsThis was a 36-month pre- and post-intervention study to evaluate the effect of implementing process improvements at a community ED from January 2010 to December 2012. The intervention comprised streamlining triage by having patients accepted into internal waiting areas immediately after triage. Within the ED, parallel processes unfolded, and there was no restriction on when registration occurred or which health care provider a patient saw first. Flexible nursing ratios allowed nursing staff to redeploy and move to areas of highest demand. Last, demand-based physician scheduling was implemented. The main outcome was length of stay (LOS). Secondary outcomes included time to physician initial assessment (PIA), left-without-being-seen (LWBS) rates, and left-against-medical-advice (LAMA) rates. Segmented regression of interrupted time series analysis was performed to quantify the impact of the intervention, and whether it was sustained.ResultsPatients totalling 251,899 attended the ED during the study period. Daily patient volumes increased 17.3% during the post-intervention period. Post-intervention, mean LOS decreased by 0.64 hours (p<0.005). LOS for non-admitted Canadian Triage and Acuity Scale 2 (-0.58 hours, p<0.005), 3 (-0.75 hours, p<0.005), and 4 (-0.32 hours, p<0.005) patients also decreased. There were reductions in PIA (43.81 minutes, p<0.005), LWBS (35.2%, p<0.005), and LAMA (61.9%, p<0.005).ConclusionA combination of process improvements in the ED was associated with clinically significant reductions in LOS, PIA, LWBS, and LAMA for non-resuscitative patients.

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