Anderson, Philip Dean

Jacobsen, Peter

Sepúlveda Estay, Daniel Alberto

Sørup, Christian Michel

Online Research Database In Technology

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Downloaded from orbit.dtu.dk on: Dec 20, 2017Tradeoffs between alleviating emergency department crowding and return visitsSørup, Christian Michel; Sepúlveda Estay, Daniel Alberto; Jacobsen, Peter; Anderson, Philip DeanPublication date:2014Link back to DTU OrbitCitation (APA):Sørup, C. M., Sepúlveda Estay, D. A., Jacobsen, P., & Anderson, P. D. (2014). Tradeoffs between alleviatingemergency department crowding and return visits. Poster session presented at 6th Danish Emergency MedicineConference, Odense, Denmark.TRADEOFFS BETWEEN ALLEVIATING EMERGENCY DEPARTMENT CROWDING AND RETURN VISITS Christian Michel Sørup1,2,3, Daniel Alberto Sepulveda Estay4, Peter Jacobsen1, Philip Dean Anderson5  for the 6th Danish Emergency Medicine Conference     INTRODUCTION METHODS  METHODS OBJECTIVE  To analyze the effects of a local protocol with system-wide effect on ED crowding. The protocol is activated when ED predefined census- and boarders levels are exceeded   To rank other parameters according to ED crowding leverage potential including inpatient capacity, bed assignment time, transfer time, and incoming elective patients  Setting: The Emergency Department at Beth Israel Deaconess Medical Center (Boston, MA)  Approach: A system dynamics simulation model depicting 1) the admission process, 2) two feedback loops being the inpatient capacity and returning patients flow upon premature discharge, and 3) flow of incoming elective patients  Data: ED census, hourly patient arrivals, patients awaiting bed assignment, and boarders data from October 2013 utilized  Baseline model and stressed model used for interpretation   Despite multiple attempts to alleviate emergency department (ED) crowding, the problem persists   High leverage points for ED crowding are yet to be identified 1Department of Management Engineering, Technical University of Denmark, Kongens Lyngby, Denmark; 2Department of Emergency Medicine, Nordsjællands Hospital, Hillerød, Denmark; 3Department of Emergency Medicine, Herlev Hospital, Herlev, Denmark; 4MIT Sloan School of Management, Boston, MA; 5Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA RESULTS CONCLUSION    Baseline model identified bed assignment time and transfer time as having most leverage to clear ED congestion  Stressed model proved that the local protocol was sensitive to changes in ED boarders trigger only  System dynamics is a promising technique to enhance understanding of complex systems  DISCUSSION  Possible to extend model to include human behavior such as work load compliance  Focus on transition between departments, i.e. broaden system boundaries  Management flight simulators, as the one developed, enable a better understanding of how the system will behave over time under different policy scenarios Baseline model: Stressed model: -1,6% -1,6% -2,6% -2,5% 5,7% 5,5% 0,6% 0,6% -4,0%-2,0%0,0%2,0%4,0%6,0%8,0%ED BoardersED CensusAdmitted PatientsOccupancySensitivity analysis of ED Boarders on four outcome variables decrease increase-20,0% -15,0% -10,0% -5,0% 0,0% 5,0% 10,0% 15,0%Mean-Incoming Elective PatientsTotal Available Inpatient BedsBed Assignment TimeTransfer TimeOccupancy decrease increase-25,0% -20,0% -15,0% -10,0% -5,0% 0,0% 5,0% 10,0% 15,0%Mean-Incoming Elective PatientsTotal Available Inpatient BedsBed Assignment TimeTransfer TimeAdmitted Patients decrease increase-6,0% -5,0% -4,0% -3,0% -2,0% -1,0% 0,0% 1,0% 2,0% 3,0% 4,0% 5,0%Bed Assignment TimeTransfer TimeMean-Incoming Elective PatientsTotal Available Inpatient BedsED Census decrease increase-60,0% -40,0% -20,0% 0,0% 20,0% 40,0% 60,0%Transfer TimeBed Assignment TimeMean-Incoming Elective PatientsTotal Available Inpatient BedsED Boarders decrease increase Tornado graphs (shown on the right)  show potential leverage of selected parameters for ED crowding  Baseline model: Changed bed assignment- and transfer times has great effect on crowding but not occupancy. Increased capacity proved not to be a primary means to alleviate crowding  Stressed model: Sensitivity analysis of local protocol show an effect on changing ED boarders trigger. ED census trigger had no effect   RESULTS ED patientin triagepatientarrivalsED patient receivingtreatment anddiagnosis servicestriage completiondischargeED boarderstransferAdmitted patientsoccupancy rate+patient releaseRelease timerelease timeadjustmentpolicy release timenormal releasetimepatient releaseimprovementfactorElective patientsrequiring admissionto inpatientchange in incomingelective patientsnon-ED patientadmision-++ED patient awaitinginpatient bedadmissionrequiringadmissionadmission-Rreturning patientsBinpatient bedcapacity restrainttotal availableinpatient capacity

Tradeoffs between alleviating emergency department crowding and return visits

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Tradeoffs between alleviating emergency department crowding and return visits

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