The ability to adapt and utilize emergency facilities is a critical element in responding to surges resulting from man-made and natural events. The current stresses on emergency services throughout the country find few adequately prepared to effectively absorb a sudden increase in patients along with some of the potential special requirements, such as quarantining of epidemic patients and mass decontamination. This article reviews major findings of the federally funded ER One project, a research initiative that has described a number of facility strategies, which should be considered in planning new emergency facilities. An early case study in the application of these principles at the recently completed Tampa General Hospital emergency service is provided, illustrating how, when integrated into the early planning and design, many of the ER One recommendations can be implemented at modest capital cost increases.
Estimating the required number of emergency service treatment beds must be sensitive to utilization patterns and strategic operational assumptions. This article describes key issues and illustrates techniques for the analysis of arrival and service times. Seasonal arrival patterns, time of day of arrivals, and common statistical distributions for length of stay are discussed. Alternative modeling approaches to estimate future bed needs are described, including visits/year per treatment space, simple queuing modeling, and detailed computer simulation. Sample estimates of treatment rooms needs are provided for typical arrival rates and lengths of stay. A generalized regression model based on the simulation trials is suggested for cases that fall outside of the illustrated simulation case studies.
Emergency services continue to evolve new operational and facility concepts in response to increasing demand for care and pressures for efficient, and safe, patient management. This article describes new models for "intake" of patients and for responding to peak demand that are radically changing the traditional emergency service. Application of Six Sigma and "Lean" analysis techniques are demonstrating dramatic improvements in throughput times and in the utilization of treatment spaces. This article provides an overview of the application of Lean concepts to emergency services. Case studies of Mary Washington Hospital and Banner Health Corporation illustrate the result of application of these tools. Implication for the required patient care areas and design concepts are also discussed.
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