Emergency department resilience to disaster‐level overcrowding: A component resilience framework for analysis and predictive modeling

Abstract

Overcrowding poses a serious challenge to the operations of health care facilities, especially those with a mandate to provide emergency care. A better understanding of emergency department (ED) performance during disaster‐level overcrowding is a key to increasing a facility's resilience, optimizing patient outcomes, and more effectively allocating resources. With this in mind, this study quantitatively examines the extent to which different factors contribute to the resilience of hospital EDs during disaster‐level overcrowding events. A modeling framework was developed in collaboration with the Carilion Clinic ED, a level one trauma center in Virginia. The testing and analysis of the approach is based on data from actual disaster‐level overcrowding events that occurred in the Spring of 2016. Results indicate that by considering not only the capacity for resisting such events but also the capacity for recovering from them more quickly, hospital decision makers can improve both their operational effectiveness and the patient experience. Furthermore, by using our framework to identify precipitating factors and predict severe overcrowding, hospital decision makers can implement changes to improve the future resilience of their ED to such overcrowding events.

Lessons Learned from Battling COVID-19: The Korean Experience

“…Many seriously ill patients with the virus were diagnosed or infected in ER. Even in a normal day, ER operates at the disaster level [ 47 ]. The COVID-19 pandemic severely tested the agility, flexibility, and resilience of ER operations at every hospital.…”

Editorial: Delivering effective healthcare at lower cost: Introduction to the special issue

“…The papers are presented in two broad groupsoperational and strategic-based on their level of investigation. Two papers describe hospital-emergency-department operations (Berry Jaeker & Tucker, 2020;Davis, Zobel, Khansa, & Glick, 2020). Two papers (Catena, Dopson, & Holweg, 2020;Lee, Venkataraman, Heim, Roth, & Chilingerian, 2020) examine how operational policies set by a national health system affect the delivery of healthcare.…”

“…The paper, "Emergency department resilience to disaster level overcrowding: A component resilience framework for analysis and predictive modeling," by Davis et al (2020) seeks to better predict occurrences of severe overcrowding as defined by a National Emergency Department Overcrowding Scale (NEDOCS) score exceeding 180. Because extra capacity is generally seen as expensive, patients are expected to wait for long periods of time to be served.…”

“…Two papers (Ding, Peng, Heim, &Jordan, 2020 andMishra, Salzarulo, &Modi, 2020) examine how strategic approaches taken by hospitals, possibly in response to national health-system policies, affect the delivery of healthcare in those hospitals. Two papers describe hospital-emergency-department operations (Berry Jaeker & Tucker, 2020;Davis, Zobel, Khansa, & Glick, 2020). Two papers (Dreyfus, Nair, & Rosales, 2020;Mukherjee & Sinha, 2020) examine perioperative services.…”

“…Because extra capacity is generally seen as expensive, patients are expected to wait for long periods of time to be served. The paper, "Emergency department resilience to disaster level overcrowding: A component resilience framework for analysis and predictive modeling," by Davis et al (2020) seeks to better predict occurrences of severe overcrowding as defined by a National Emergency Department Overcrowding Scale (NEDOCS) score exceeding 180. The focal hospital experienced overcrowding on more than 40% of its operating days.…”