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Published on: January 15, 2017
Analyzing discharge strategies during acute care: a discrete-event simulation study
Elizabeth A Crawford1, Pratik J Parikh1, Nan Kong2
1Department of Biomedical, Industrial and Human Factors Engineering, Wright State University, Dayton, OH (EC, PJP).
Summary
Proactive hospital discharge strategies significantly cut emergency department wait times but increased patient readmissions. These findings highlight the complex trade-offs in hospital operations and patient care.
Area of Science:
- Healthcare Operations Research
- Hospital Management
- Patient Flow Optimization
Background:
- Acute care hospitals face challenges managing patient flow from emergency departments (ED) to inpatient units.
- Discharge timing significantly impacts hospital operations, including ED wait times, ambulance diversions, and patient readmissions.
Purpose of the Study:
- To model patient pathways in an acute care hospital using discrete-event simulation.
- To analyze the effects of static versus proactive discharge strategies on ED wait times, boarding, ambulance diversions, and readmissions.
Main Methods:
- Developed a discrete-event simulation model of patient flow through an acute care hospital.
- Explicitly modeled the impact of discharge timing on key hospital performance metrics.
- Compared one static and two proactive discharge strategies.
Main Results:
- Proactive discharge strategies significantly reduced ED waiting and boarding times (P < 0.01).
- However, proactive strategies led to a substantial increase in patient readmissions.
- Findings were sensitive to patient arrival rates and ambulance diversion criteria.
Conclusions:
- Optimizing discharge timing is crucial for balancing hospital efficiency and patient outcomes.
- Inpatient discharge decisions have objective impacts on ED crowding and readmission rates.
- Further research is needed to refine discharge strategies to minimize readmissions while maintaining operational efficiency.
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