Models for improving patient throughput and waiting at hospital emergency departments

Background: Overcrowding diminishes Emergency Department (ED) care delivery capabilities. Objectives: We developed a generic methodology to investigate the causes of overcrowding and to identify strategies to resolve them, and applied it in the ED of a hospital participating in the study. Methods: We utilized Discrete Event Simulation (DES) to capture the complex ED operations. Using DES results, we developed parametric models for checking the effectiveness and quantifying the potential gains from various improvement alternatives. We performed a follow-up study to compare the outcomes before and after the model recommendations were put into effect at the hospital participating in the study. Results: Insufficient physicians during peak hours, the slow process of admitting patients to inpatient floors, and laboratory and radiology test turnaround times were identified as the causes of reduced ED throughput. Addition of a physician resulted in an almost 18% reduction in the ED Main discharged patient length of stay. Conclusion: The case study results demonstrated the effectiveness of the generic methodology. The research contributions were validated through statistically significant improvements seen in patient throughput and waiting time at the hospital participating in the study.