Leveraging discrete event simulation modeling to evaluate design and process improvements of an emergency department

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.