Leveraging discrete event simulation modeling to evaluate design and process improvements of an emergency department
Open Access
- 21 December 2022
- journal article
- Published by Journal of Design for Resilience in Architecture & Planning in Journal of Design for Resilience in Architecture and Planning
- Vol. 3 (3), 397-408
- https://doi.org/10.47818/drarch.2022.v3i3064
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.Keywords
This publication has 31 references indexed in Scilit:
- The Association Between Length of Emergency Department Boarding and MortalityAcademic Emergency Medicine, 2011
- Review of Modeling Approaches for Emergency Department Patient Flow and Crowding ResearchAcademic Emergency Medicine, 2011
- Simulation for emergency care process reengineering in hospitalsBusiness Process Management Journal, 2010
- The Effect of Physician Triage on Emergency Department Length of StayThe Journal of Emergency Medicine, 2010
- Impact of co-located general practitioner (GP) clinics and patient choice on duration of wait in the emergency departmentEmergency Medicine Journal, 2010
- A rapid admission protocol to reduce emergency department boarding timesHeart, 2010
- Effects of implementing a rapid admission policy in the EDThe American Journal of Emergency Medicine, 2007
- Simulating discrete event systems with UML and JAVAEnvironmental Science and Pollution Research, 2006
- Suicide Rates Among Physicians: A Quantitative and Gender Assessment (Meta-Analysis)American Journal of Psychiatry, 2004
- Emergency department overcrowding in the United States: an emerging threat to patient safety and public healthEmergency Medicine Journal, 2003