Abstract
This study exemplifies the practical application of the Discrete Event Simulation (DES) approach for evaluating the effectiveness of suggested processes and design modifications in improving the existing bottlenecks of an Emergency Department. EDs are under escalating pressure to deliver efficient care while handling considerable challenges, such as overcrowding, delays, length of stay, safety risks, or staffing. Many ED appointments are non-urgent and can be treated in an alternative outpatient setting. Suitable demand-capacity matching and adjusted admission protocols reduce ED patients' Length of Stay (LOS) and improve boarding times. Alternatively, new design suggestions include applying results-pending areas where lower acuity patients wait for their pending lab or imaging results. In this study, DES assesses underlying conditions and existing bottlenecks in an existing ED. The current ED flow involved a "pull-until-full" for exam room boarding and bedside registration after triage fulfillment. Nonetheless, the ED experienced boarding delays for patients waiting to be admitted into the hospital. This study explored two scenarios in DES as potential alternatives for reducing LOS: the implication of a "rapid-admit" protocol and a "results-pending" area. Findings showed that the Rapid-Admit process reduced the admitted patient's LOS by 16%. On average, the results-pending implication reduced the admit LOS by an average of 32% across all ESI levels. These findings suggest the importance of process, staffing, and spatial modifications to achieve ED operational improvements. DES enabled a data-driven approach to evaluate bottlenecks, enhance architect-owner communication, and optimize the system for future design and process improvement alternatives.
Publisher
Journal of Design for Resilience in Architecture & Planning
Subject
General Earth and Planetary Sciences,General Environmental Science
Reference38 articles.
1. Amarasingham, R., Swanson, T. S., Treichler, D. B., Amarasingham, S. N., & Reed, W. G. (2010). A rapid admission protocol to reduce emergency department boarding times. BMJ Quality & Safety, 19(3), 200–204.
2. American Hospital Association. (2015). Emergency department visits, emergency department visits per 1,000, and number of emergency departments, 1991–2010.
3. Bal, A., Ceylan, C., & Taçoğlu, C. (2017). Using value stream mapping and discrete event simulation to improve efficiency of emergency departments. International Journal of Healthcare Management, 10(3), 196–206.
4. Boulain, T., Malet, A., & Maitre, O. (2020). Association between long boarding time in the emergency department and hospital mortality: a single-center propensity score-based analysis. Internal and Emergency Medicine, 15(3), 479–489.
5. Brailsford, S. C., & Hilton, N. A. (2001). A comparison of discrete event simulation and system dynamics for modelling health care systems.