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Computer Simulation to Assess Emergency Department Length of Stay in Pediatric Traumatic Brain Injury
Tianshu Feng1, Ali Ajdari2, Linda Ng Boyle3
1From the George Mason University, Fairfax, VA.
Insights
High emergency department (ED) arrival rates for pediatric traumatic brain injury (TBI) prolong hospital length of stay (LOS). Optimizing ED processes and trauma bed locations can significantly reduce this LOS.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care Systems
- Health Services Research
Background:
- Emergency department (ED) length of stay (LOS) is a critical metric in pediatric trauma care.
- Understanding factors influencing ED LOS for pediatric traumatic brain injury (TBI) is essential for optimizing patient flow and outcomes.
Purpose of the Study:
- To investigate the impact of emergency department (ED) arrival rates, care processes, and physical layout on ED length of stay (LOS) for pediatric traumatic brain injury (TBI) patients.
- To identify key determinants of prolonged ED LOS in pediatric trauma centers.
Main Methods:
- Utilized process flows and value stream maps across three level I pediatric trauma centers.
- Employed computer simulation models to analyze "what if" scenarios related to ED arrival rates.
Main Results:
- Observed variations in prearrival preparation times, ED physical layouts, and process durations.
- Shorter prearrival preparation, trauma bed proximity to diagnostics/treatment, and ED arrival rates exceeding 20 patients/day were associated with prolonged ED LOS.
- Computer simulations indicated that relocating trauma beds could reduce ED LOS irrespective of patient volume.
Conclusions:
- Elevated ED arrival rates for pediatric TBI patients can significantly extend ED LOS.
- Modifications to ED processes and strategic trauma bed placement can effectively mitigate increases in ED LOS.
Objectives:
Our study aimed to identify how emergency department (ED) arrival rate, process of care, and physical layout can impact ED length of stay (LOS) in pediatric traumatic brain injury care.
Methods:
Process flows and value stream maps were developed for 3 level I pediatric trauma centers. Computer simulation models were also used to examine "what if" scenarios based on ED arrival rates.
Results:
Differences were observed in prearrival preparation time, ED physical layouts, and time spent on processes. Shorter prearrival preparation time, trauma bed location far from diagnostic or treatment areas, and ED arrival rates that exceed 20 patients/day prolonged ED LOS. This was particularly apparent in 1 center where computer simulation showed that relocation of trauma beds can reduce ED LOS regardless of the number of patients that arrive per day.
Conclusions:
Exceeding certain threshold ED arrival rates of children with traumatic brain injury can substantially increase pediatric trauma center ED LOS but modifications to ED processes and bed location may mitigate this increase.
