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The following outlines a few examples of how ED Simulation is used to predict the results of workflow changes in Emergency Departments.
Is my overcrowded ED caused by crowding in the rest of the hospital, leading to "boarders" who are held in the ED until a bed opens up in an in-patient unit? What if admission processing time was reduced by one hour? By 2 hours?
Base Hospital: 257 patients per day: 11 physicians
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Patient throughput (average)
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Physician utilization
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Base
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4 hours 56 minutes
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77%
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Admit times reduced 1 hour
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4 hours 24 minutes
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84%
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Admit times reduced 2 hours
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3 hours 36 minutes
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93%
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Are my physicians underutilized because there aren't enough beds? Would adding a couple of beds decrease patient time-in-system and increase physician utilization? What about a few more beds?
Base Hospital: 272 patients per day: 11 physicians: 25 ED beds
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Patient throughput (average)
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Physician utilization
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Base
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4 hours 51 minutes
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77%
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27 beds
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4 hours 43 minutes
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81%
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30 beds
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4 hours 25 minutes
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94%
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35 beds
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3 hours 46 minutes
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100%
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Unlimited beds
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3 hours 43 minutes
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100%
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What's my expected loss in revenue if we have to divert patients because of overcrowding? How many patients would be diverted? What would I have to change to reduce/ eliminate diversion? Lab or X-Ray turnaround time? Physician scheduling? Specialist on-call response times?
Base Hospital: 272 patients per day: 11 physicians: 25 ED beds: 90 minute lab/X-Ray turnaround time
Diversion Criteria: EMS arrival wait time for bed > 60 minutes or All ED beds are occupied
Diversion Duration: 2 hours
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Patient throughput (average)
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Physician utilization
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Diverted
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Base
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3 hours 08 minutes
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85%
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30 EMS patients
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60 minutes lab/X-Ray
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2 hours 43 minutes
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89%
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26 EMS patients
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30 minutes lab/X-Ray
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2 hours 32 minutes
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92%
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20 EMS patients
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1 additional physician per shift
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2 hours 08 minutes
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70%
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30 EMS patients
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Specialist response time reduced by 50%
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3 hours 07 minutes
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86%
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30 EMS patients
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If I have the physician perform the initial triage, I may reduce the metric of "time to see a doctor", but what is the effect of total patient time-in- system? Shorter? Longer? How about if the physician does both the initial triage and assessment? Would I have to increase the number of scheduled physicians? What about the metric "time to assessment?"
Base Hospital: 272 patients per day: 11 physicians: 25 ED beds
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Patient throughput (average)
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Physician utilization
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Time to see a physician
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Triage by non physician
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3 hours 08 minutes
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85%
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1 hour 13 minutes
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Triage by physician
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5 hours 28 minutes
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93%
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1 hours 15 minutes
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Triage & assess by physician
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4 hours 9 minutes
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100%
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2 hours 2 minutes
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Would I have to increase the number of scheduled physicians? How about double?
Base Hospital: 272 patients per day: 22 physicians: 25 ED beds
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Patient throughput (average)
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Physician utilization
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Time to see a physician
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Triage by non physician
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2 hours 06 minutes
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46%
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17 minutes
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Triage by physician
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2 hours 19 minutes
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56%
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7 minutes
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Triage & assess by physician
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2 hours 7 minutes
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58%
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9 minutes
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