The DH Accident and Emergency Department Model: A National Generic Model Used Locally

Abstract

The Department of Health (DH) Accident and Emergency (A&E) simulation model was developed by Operational Research analysts within DH to inform the national policy team of significant barriers to the national target for 98% of all A&E attendances to be completed (discharged, transferred or admitted) within four hours of arrival in England by December 2004. This paper discusses why the model was developed, the structure of the model, and the impact when used to inform national policy development. The model was then used as a consultancy tool to aid struggling hospital trusts to improve their A&E departments. The paper discusses these experiences with particular reference to the challenges of using a 'generic' national model for 'specific' local use.

Integrated decision making in healthcare : an operations research and management science perspective

“…Equipment may be required for emergency procedures, including treatment beds, treatment chairs and diagnostic equipment [91,106,393]. In general, diagnostic testing is considered outside the control of the emergency care services [181]. Emergency patients may require an X-ray or other diagnostic testing, and may have to compete with inpatients and outpatients for diagnostic resource capacity.…”

“…Emergency patients may require an X-ray or other diagnostic testing, and may have to compete with inpatients and outpatients for diagnostic resource capacity. Ineffective management of the diagnostic department causes delays in the emergency care services [181]. Installing diagnostic equipment in the ED may decrease the waiting time for diagnostic results, and therewith the overall length of stay of a patient in the ED [393].…”

“…Staff in emergency care services is composed of different skill and responsibility levels, for example doctors, emergency nurses and support staff [60,181,220,282,311,375,376,393,532]. Required staffing dimensions, and thereby staff costs, may be reduced by passing on non-critical patients from doctors to lower-qualified, less-costly staff, releasing doctors to work on the critical cases [60].…”

“…For example, staff members may be 'on call' while working elsewhere or being off-duty, and they are called upon when additional staff is required in the ED to cope with unexpected demand peaks [376]. Methods: computer simulation [16,40,60,91,165,181,186,267,311,315,375,412,429,526,532], heuristics [38], mathematical programming [38,39,165,375,376,412], queueing theory [106,220,446,468], literature review [62,282,393].…”

“…For example, a 'fast-track system' in the ED separates the patients with minor injuries and illnesses from the more severe traumas [106,282,349]. It reduces waiting time for patients with minor injuries and illnesses [349], but may lead to increased waiting time for the other patient groups, since less resources are available for these groups [181]. This may be acceptable, when the effect is not too large [349] and the increased waiting times are still within the set targets for each patient group [60,282].…”