An integrated approach for designing in-time and economically sustainable emergency care networks: A case study in the public sector

Abstract

Emergency Care Networks (ECNs) were created as a response to the increased demand for emergency services and the ever-increasing waiting times experienced by patients in emergency rooms. In this sense, ECNs are called to provide a rapid diagnosis and early intervention so that poor patient outcomes, patient dissatisfaction, and cost overruns can be avoided. Nevertheless, ECNs, as nodal systems, are often inefficient due to the lack of coordination between emergency departments (EDs) and the presence of non-value added activities within each ED. This situation is even more complex in the public healthcare sector of low-income countries where emergency care is provided under constraint resources and limited innovation. Notwithstanding the tremendous efforts made by healthcare clusters and government agencies to tackle this problem, most of ECNs do not yet provide nimble and efficient care to patients. Additionally, little progress has been evidenced regarding the creation of methodological approaches that assist policymakers in solving this problem. In an attempt to address these shortcomings, this paper presents a three-phase methodology based on Discrete-event simulation, payment collateral models, and lean six sigma to support the design of in-time and economically sustainable ECNs. The proposed approach is validated in a public ECN consisting of 2 hospitals and 8 POCs (Point of Care). The results of this study evidenced that the average waiting time in an ECN can be substantially diminished by optimizing the cooperation flows between EDs.

A fuzzy hybrid decision-making framework for increasing the hospital disaster preparedness: The colombian case

“… Networks and Communications (C3) Emergency service network (SC19) Communications channels/equipment (SC20) Information Quality (SC21) It assesses the hospitals' ability to manage the collaboration flows with the nodes integrating the emergency service networks. In addition, it reveals how each hospital use different communication channels for optimizing the information flows during outbreaks [ 74 ]. Transport (C4) Number of ambulances (SC22) Heliport area (SC23) Safety (SC24) Road accessibility (SC25) It verifies how ready the transportation infrastructure and fleet of a particular hospital are for facing the logistical demands, especially the patient transfers, emanating from the disaster scenario [ 85 ].…”

“…On a different note, it is of paramount relevance to look into the main causes leading to poor potential performance so that sectorial improvement interventions can be deployed for increasing the disaster preparedness of the entire healthcare system. VIKOR can efficaciously fulfill the methodological requirements behind these considerations since: i) it calculates the Q index, which can represent the multidimensional nature of hospital disaster preparedness, ii) it allows ranking the hospitals based on the Q index, and iii) it pinpoints the weaknesses of each hospital by considering the contribution of each to [ 74 , 75 ].…”

“…This patient influx situation can be observed in the case of any disasters such as earthquakes, pandemics, terrorist and biological attacks. In these cases, medical institutions should be available for infrastructure and resource planning [ [8] , [9] , [10] ]. As can be understood from the studies in which the most important criteria in the disaster preparedness of hospitals are discussed in the literature, disasters directly affect the activities of hospitals [ [11] , [12] , [13] , [14] ]; and [ [15] , [16] , [17] ].…”

“…This is named VIKOR. It is initially proposed by Opricovic [ 21 ] and applied to various healthcare problems such as evaluation of influenza intervention strategies [ 30 ], evaluation of hospital-based post-acute care [ 31 ], health risk assessment [ 32 , 33 ], selection of most appropriate classifier for people with dementia [ 10 ], hospital service quality evaluation [ 34 ], medical supplier selection [ 35 ] and so on. It ranks alternatives and generates the compromise solution which is the nearest to the “ideal solution”.…”

Process Improvement Approaches for Increasing the Response of Emergency Departments against the COVID-19 Pandemic: A Systematic Review

“…Not responding effectively to this scenario has resulted in a rising risk of serious health complications in affected patients, the spread of nosocomial infections within the ED wards, and a concerning mortality rate which evidence a lack of concerted intervention where the stakeholders can converge in the search for real efficacious and efficient process improvement programs. A representation of these shortcomings can be noted in the collapse of EDs which has accentuated the need for promoting the design and implementation of emergency care networks or "big hospitals" as an alternative strategy that may address the demand peaks caused by the ongoing outbreak and population dynamics [102][103][104]. This situation is mainly reported in emerging countries where some hospitals have been urged to transfer patients to institutions from other regions [105].…”