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Data-Driven Design Strategies to Address Crowding and Boarding in an Emergency Department: A Discrete-Event
Shabboo Valipoor1, Mohsen Hatami2, Hesamedin Hakimjavadi3
1Department of Interior Design, College of Design, Construction & Planning, 3463University of Florida, Gainesville, FL, USA.
HERD
|November 12, 2020
Summary
Implementing hallway care and dedicated EMS triage significantly reduces emergency department length of stay and congestion. These strategies improve patient flow and reduce wait times for all patients.
Area of Science:
- Emergency Medicine
- Healthcare Operations Research
- Hospital Design
Background:
- Emergency department (ED) crowding is a significant issue, leading to longer service times and patients leaving without being seen.
- Prolonged lengths of stay (LOS) in trauma centers negatively impact patient care and resource utilization.
Purpose of the Study:
- To evaluate the impact of two data-driven strategies on reducing prolonged lengths of stay (LOS) in a Level 1 trauma center.
- To analyze the effect of physical environment modifications on emergency department (ED) patient flow and congestion.
Main Methods:
- A discrete-event simulation model was developed using historical ED data and expert estimates.
- Two scenarios were simulated: initiating care and boarding patients in hallways ('hallway care') and establishing a dedicated triage space for emergency medical services (EMS) patients ('EMS triage').
- Key performance indicators analyzed included LOS, time spent in exam rooms and hallways, service time, blocked time, and utilization rate.
Main Results:
- The 'hallway care' scenario alone reduced LOS and exam room time for EMS patients.
- Combining 'hallway care' with 'EMS triage' significantly lowered LOS and exam room time for all patients (EMS and walk-in).
- The combined strategies demonstrated significant improvements in overall ED flow metrics.
Conclusions:
- Boarding admitted patients in ED exam rooms is discouraged; if hallway boarding is necessary, optimize these spaces.
- Prioritize alternative locations for boarding admitted patients, either within or outside the ED.
- Establishing a dedicated triage area for EMS patients is recommended to improve ED efficiency.
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