Simulation-Based Design of ED Operations with Care Streams to Optimize Care Delivery and Reduce Length of Stay in the Emergency Department

Abstract

Faced with the opportunity to significantly deviate from classic operations, a new emergency department (ED) and novel strategy for patient care delivery were simultaneously initiated with the aid of model-based simulation. To answer the design and implementation questions, a traditional strategy for construction of discrete-eventmodel simulation was employed to define ED operations for a newly constructed facility in terms of workflow, variables, resources, structure, process logic and associated assumptions. Benefits were achieved before, during and after implementation of an unprecedented operations strategy-i.e., the organization of the ED care delivery around four care streams: Critical, Diagnostic, Therapeutic and Fast Track. Prior to opening, it shed light on the range of context variables where benefits might be anticipated, and it facilitated staff understanding and judgements of performance. Two years after opening, the operations data is compared to the simulation with encouraging results that shed light on where to continue pursuit of improvement.

Patient Flow Simulation Using Historically Informed Synthetic Data

“…Ahmed and Alkhamis designed a DES system that allows for stochastically varying constraints focusing on emergency department staffing required to maximise patient throughput and minimise waiting time [8]. As a final example, Steward et al implemented a simulation to investigate workflow associated with patient care streams [9]. In this scenario, patient journey was determined by their care stream (critical, diagnostic, therapeutic, fast-track, or resuscitation), and the authors found this method reduced both patient LOS and wait time.…”

Throughput delays: causes, predictors, and outcomes – observational cohort in a Swiss emergency department

“…A generic model of ED operations reduces the complexity of all processes to three: input, throughput, and output [11]. Each of these main processes may be modified or improved, but systemic elements, such as patient numbers or hospital beds, are given and render input and output that are difficult to tweak from an ED perspective [12].…”