Optimizing Emergency Department Patient Flow Through Bed Allocation Strategies: A Discrete-Event Simulation Study.

Area of Science:

• Healthcare Management
• Hospital Operations Research
• Patient Flow Optimization

Background:

• Emergency department (ED) overcrowding and prolonged length of stay (LOS) are persistent challenges in healthcare systems.
• Effective resource utilization and patient flow management are crucial for hospital efficiency.

Purpose of the Study:

• To compare four distinct bed allocation strategies for optimizing patient flow and resource utilization in a regional teaching hospital.
• To identify the most effective strategy for reducing prolonged ED LOS and improving hospital operations.

Main Methods:

• Development of a discrete-event simulation model using one year of hospital data (29,718 ED visits).
• Evaluation of four strategies: intra-departmental bed sharing, optimized bed allocation, cross-departmental bed lending, and combined optimization with bed borrowing.
• Validation of the simulation model using t-tests against actual hospital data.

Main Results:

• All evaluated strategies showed improvement over current operations.
• Strategy 4 (combined optimization with bed borrowing) was most effective, maintaining stable ED nursing utilization (45.65%) and significantly reducing extended LOS.
• Rates of ED LOS exceeding 6, 12, and 24 hours were reduced to 2.48%, 0.38%, and 0.12% respectively.

Conclusions:

• Strategic bed allocation combined with controlled bed-sharing policies can achieve substantial reductions in extended ED LOS (up to 30%) without increasing nursing workload.
• The optimal strategy (Strategy 4) effectively manages ED patient flow by combining optimization with resource sharing, leading to improved patient outcomes and operational efficiency.