Modeling Emergency Department crowding: Restoring the balance between demand for and supply of emergency medicine

Abstract

Emergency Departments (EDs) worldwide are confronted with rising patient volumes causing significant strains on both Emergency Medicine and entire healthcare systems. Consequently, many EDs are in a situation where the number of patients in the ED is temporarily beyond the capacity for which the ED is designed and resourced to manage―a phenomenon called Emergency Department (ED) crowding. ED crowding can impair the quality of care delivered to patients and lead to longer patient waiting times for ED doctor’s consult (time to provider) and admission to the hospital ward. In Singapore, total ED attendance at public hospitals has grown significantly, that is, roughly 5.57% per year between 2005 and 2016 and, therefore, emergency physicians have to cope with patient volumes above the safe workload. The purpose of this study is to create a virtual ED that closely maps the processes of a hospital-based ED in Singapore using system dynamics, that is, a computer simulation method, in order to visualize, simulate, and improve patient flows within the ED. Based on the simulation model (virtual ED), we analyze four policies: (i) co-location of primary care services within the ED, (ii) increase in the capacity of doctors, (iii) a more efficient patient transfer to inpatient hospital wards, and (iv) a combination of policies (i) to (iii). Among the tested policies, the co-location of primary care services has the largest impact on patients’ average length of stay (ALOS) in the ED. This implies that decanting non-emergency lower acuity patients from the ED to an adjacent primary care clinic significantly relieves the burden on ED operations. Generally, in Singapore, there is a tendency to strengthen primary care and to educate patients to see their general practitioners first in case of non-life threatening, acute illness.

Main Features and Control Strategies to Reduce Overcrowding in Emergency Departments: A Systematic Review of the Literature

“…23 A difficult and delayed access by patients to diagnostic tests prescribed by their family doctor can lead to improper ED use and its consequent overcrowding. Ansah et al 24 and Ferreira Amorim et al 17 concluded that there is an inappropriate ED use and that an enhanced primary care system is needed to reduce ED crowding. Indeed, Wang et al 6 found that families continue to use ED to obtain care for elderly or disabled patients, whose needs should be met in a long-term care facility.…”

They Told Me “This Isn’t a Hotel”: Young People’s Experiences and Perceptions of Care When Presenting to the Emergency Department with Suicide-Related Behaviour

“…Most recently, in Australia, the COVID-19 pandemic has resulted in a reconfiguration of ED services, which has led to increasing levels of "ambulance ramping" [48,49]. These factors have led to increases in hospital and ED overcrowding, longer waiting periods, poorer patient outcomes [50] and patients leaving without having their concerns attended to [46,51]. These multiple and confounding factors have ramifications for young people presenting to EDs with suicidal behaviour.…”

Identifying indicators influencing emergency department performance during a medical surge: A consensus-based modified fuzzy Delphi approach

“…During such periods, hospitals play essential roles in delivering health care services to patients. As hospitals are not only directly subjected to the consequences of the mentioned catastrophic events, they are also required to sustain and even increase their capacity to meet the increased disaster-originated demands [ 2 , 3 ]. The concept of surge capability in healthcare is well-defined in various literature [ 4 – 7 ].…”