Emergency department treatment process planning: a field research, case analysis, and simulation approach

The coronavirus disease 2019 (COVID-19) has forced accelerated optimization of Emergency Department (ED) process, and simulation tools offer an alternative approach to strategic assessment and selection.

Field research and case analysis methods were used to obtain the treatment process and medical records information from the ED of a general hospital. Minitab was used for analysis of the measurement system, and Arena was applied for simulation modelling. We established a framework for the triage protocol of ordinary and quarantined patients, analysed bottlenecks in the treatment time of the hospital's ED, and proposed an optimised management strategy.

The computed tomography (CT) pre-scheduling strategy simulation results demonstrated that longer CT room preparation times for quarantined people before their arrival (T_p) resulted in reduced CT scan and waiting times for quarantined patients, but these times were longer for ordinary patients. The nucleic acid priority strategy simulation results demonstrated that when the average daily number of ordinary patients (λ_c) was relatively stable, the hospital could guide ordinary patients to perform nucleic acid testing first followed by CT testing. However, when λ_c fluctuated greatly, the hospital could appropriately reduce the proportion of preferential nucleic acid testing. Furthermore, when λ_c was overloaded, the nucleic acid priority strategy showed no advantages. The joint analysis results demonstrated that the optimal strategy selection was significantly affected by the severity of the epidemic. The nucleic acid detection sample size optimisation strategy demonstrated that optimizing the sample size of each batch according to the number of patients could effectively reduce the waiting times for nucleic acid testing (T_n).

Simulation tools are an alternative method for strategic evaluation and selection that do not require external factors.