A flexible simulation platform to quantify and manage emergency department crowding.

Area of Science:

• Operations Research
• Healthcare Management
• Simulation Modeling

Background:

• Hospital-based Emergency Departments (EDs) face increasing unscheduled visits, challenging timely patient care.
• Declining reimbursement and ED closures necessitate enhanced operational efficiency.

Purpose of the Study:

• To develop a flexible simulation platform for hospital-based EDs using operations research techniques.
• To assess patient flow outcomes and identify operational bottlenecks.

Main Methods:

• Utilized operations research theory and a novel event-driven algorithm for priority queues.
• Developed a simulation platform to mimic U.S. average and academic ED performance metrics.
• Evaluated patient door-to-event times, leaving without being seen rates, occupancy, staffing, and resource use.

Main Results:

• Identified variable causes of ED crowding requiring site-specific solutions.
• In average EDs, provider availability is a key bottleneck; reducing boarding may not improve throughput.
• Reallocating resources to alternate care pathways expedites lower-acuity care without impacting higher-acuity patients.
• In academic EDs, bed availability is the primary bottleneck; shorter boarding times reduce crowding.

Conclusions:

• Created a robust simulation framework as a novel decision-support tool.
• ED and hospital managers can use this tool to quantify the impact of proposed patient flow changes before implementation.
• An online version of the simulation platform is available for broader accessibility.