Improvement of Hospital Emergency Department Operations Using Simulation-based Approach

Scope and method of study: The study aimed at reducing the length of stay of patients in a hospital emergency department (ED) through systematic investigation using a simulation based approach. Literature review conducted during the course of study revealed a great amount of research conducted in understanding and improving the emergency department operations. Lately, ED has become the primary facility to obtain immediate healthcare services; hence, reducing patient's length of stay in ED has become a critical issue. The research developed a high fidelity simulation model that captures the major activities that occur during the course of treatment of patients at the Stillwater Medical Center ED. Data collection and analysis was carried out to generate inputs for the simulation model. Several alternate strategies such as an additional triage station to treat less emergent patients, additional doctor during peak hours and nursing staff dedicated to treating less emergent patients were developed which aided in reducing the waiting time of patients thereby reducing the length of stay. The strategies were analyzed and their performance was compared to that of the baseline simulation model.Findings and conclusions: A different approach of treating less emergent patients was developed by adding a triage station which increased the availability of rooms and reduced waiting time of patients before a room was assigned. Addition of a triage station dedicated to treating less emergent patients reduced patient's length of stay by 6.3%. With an additional doctor during peak hours it was observed that length of stay decreased by 13%. There was a decrease of almost 9% when a nurse was dedicated to fast-track patients. Instead of being dedicated, if the nurse had a priority for fast-track patients, the model showed a decrease in length of stay of 14%. Although the study was focused on the Stillwater Medical Center ED operations, the strategies developed during the research that could also be implemented in emergency departments that operate in a similar manner. Finally, this research has proposed a strategy that could be used to treat less emergent patients quickly and efficiently and thereby achieving overall reduction in the length of stay of patients.Industrial Engineering & Managemen

Mercy Medical Center: Reducing Readmissions Through Clinical Excellence, Palliative Care, and Collaboration

Outlines strategies and practices behind low readmissions rates for heart attack, heart failure, and pneumonia patients, such as investing in advanced practice nurses who help incorporate evidence-based standards into patient care. Lists lessons learned

Improving waiting times in the Emergency Department

Waiting times in the Emergency Department cause considerable delays in care and in patient satisfaction. There are many moving parts to the ED visit with multiple providers delivering care for a single patient. Factors that have been shown to delay care in the ED have been broken down into input factors such as triaging, throughput factors during the visit, and output factors, which include discharge planning and available inpatient beds for admitted patients. Research has shown that throughput factors are an area of interest to decrease time spent in the ED that will lead to decrease waiting room times. In this Quality Improvement project, we will develop a systematic check in system with ED providers that will allow providers to identify any outstanding issues that may be delaying care or discharge. We hypothesize that this system will increase throughput in the ED by resolving any lab, radiology, or treatments that were overlooked. Reviewing the results of this QI project will allow us to see if we were effective in our timing of scheduled check-ins. Ultimately, this will reduce time spent in the waiting room by allowing more patients to be seen. In the era of the Affordable Care Act, more patients have access to affordable healthcare and will increase volume in the ED. This check-in system will allow more patients to be seen smoothly and in a timely manner that will improve and increase patient care and satisfaction in the ED

A survey of health care models that encompass multiple departments

In this survey we review quantitative health care models to illustrate the extent to which they encompass multiple hospital departments. The paper provides general overviews of the relationships that exists between major hospital departments and describes how these relationships are accounted for by researchers. We find the atomistic view of hospitals often taken by researchers is partially due to the ambiguity of patient care trajectories. To this end clinical pathways literature is reviewed to illustrate its potential for clarifying patient flows and for providing a holistic hospital perspective

Improving Quality and Achieving Equity: A Guide for Hospital Leaders

Outlines the need to address racial/ethnic disparities in health care, highlights model practices, and makes step-by-step recommendations on creating a committee, collecting data, setting quality measures, evaluating, and implementing new strategies

Taxonomic classification of planning decisions in health care: a review of the state of the art in OR/MS

We provide a structured overview of the typical decisions to be made in resource capacity planning and control in health care, and a review of relevant OR/MS articles for each planning decision. The contribution of this paper is twofold. First, to position the planning decisions, a taxonomy is presented. This taxonomy provides health care managers and OR/MS researchers with a method to identify, break down and classify planning and control decisions. Second, following the taxonomy, for six health care services, we provide an exhaustive specification of planning and control decisions in resource capacity planning and control. For each planning and control decision, we structurally review the key OR/MS articles and the OR/MS methods and techniques that are applied in the literature to support decision making

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

Achieving Efficiency: Lessons From Four Top-Performing Hospitals

Synthesizes lessons from case studies of how four hospitals achieved greater efficiency, including pursuing quality and access, customizing technology, emphasizing communications, standardizing processes, and integrating care, systems, and providers