The Patient Flow Effect of Pandemic Policies: A Hybrid Simulation Study in a Norwegian Emergency Department

Abstract

The COVID-19 pandemic required several interventions within emergency departments, complicating the patient flow. This study explores the effect of intervention policies on patient flow in emergency departments under pandemic conditions. The patient flow interventions under evaluation here are the addition of extra treatment rooms and the addition of a waiting zone. A predeveloped hybrid simulation model was used to conduct five scenarios: (1) pre-pandemic patient flow, (2) patient flow with a 20% contamination rate, (3) adding extra treatment rooms to patient flow, (4) adding a waiting zone to the patient flow, (5) adding extra treatment rooms and a waiting zone to the patient flow. Experiments were examined based on multiple patient flow metrics incorporated into the model. Running the scenarios showed that introducing the extra treatment rooms improved all the patient flow parameters. Adding the waiting zone further improved only the contaminated patient flow parameters. Still, the benefit of achieving this must be weighed against the disadvantage for ordinary patients. Introducing the waiting zone in addition to the extra treatment room has one positive effect, decreasing time that the treatment rooms are blocked for contaminated patients entering the treatment room.

The Impact of Patient Infection Rate on Emergency Department Patient Flow: Hybrid Simulation Study in a Norwegian Case

“…Our findings above confirm the findings in a previous study [ 29 ] that the intervention of implementing the waiting zone is the most effective for COVID+ patients, but may not be the most effective intervention in total, given that it negatively affects the patient flow of COVID− patients. What we now also see in the current study is that this negative effect worsens with increasing PIR.…”

“…What we now also see in the current study is that this negative effect worsens with increasing PIR. The introduction of extra treatment rooms, however, leads to a beneficial effect both for COVID+ and COVID− patients, as we saw [ 29 ], but the new finding in the current study is that this beneficial effect is less dependent on PIR—provided that the patient influx stays within the capacity of the emergency department. Thus far, the intervention of “extra treatment rooms” we had introduced in our simulation was set at four extra treatment rooms.…”

“…The simulation model input uses data from a local database called Meona at the case organization, which, among other types of data not used in this study, keeps a record of the number of patients that have been admitted into the emergency department. These Meona data, of which an illustrated excerpt is shown in Figure 3 , are numerical data representing timestamps of arrival for patients; this data is from previous work [ 29 ]. Each timestamp represents a patient agent to be inserted into the computerized simulation model.…”

“…Three main resources were introduced to the case emergency department. Table 1 below, adapted from previous work [ 29 ], describes and summarizes these three resources under focus. These resources were introduced as intervening measures to the emergency department to combat the adverse risks associated with the pandemic situation, which has been included in the computerized simulation developed for the present study.…”

“…This section aims to show the experimental decisions made during the development of the computerized simulation model utilized in this study. Overall the present study’s experimental design closely follows that of a previously published article within this research endeavor [ 29 ], except that this study focuses on the patient flow performance with increasing rates of infection among the admitted patients. This means that the different simulation runs vary in one parameter of particular interest: the patient infection rate (PIR).…”