Healthcare planning parameters affecting efficiency in emergency departments

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Emergency department (ED) inefficiency has become a major concern causing crowding and patients' extended length of stay across the United States (Carter, Pouch, & Larson, 2014). EDs are struggling to provide timely care to a steadily growing number of unscheduled emergency patients (Hurwitz et al., 2014). Decreasing compensation and rising ED closures dictate that facing this challenge requires greater operational efficiency (Hurwitz et al., 2014). This issue has been addressed by multiple researches from different disciplinary perspectives. A few published studies have examined the problem and hypothesized possible solutions in relation to healthcare planning and physical design of emergency departments. According to Pati et al. (2014) one-way traffic and isolated routes for different acuity level patients may improve efficiency in EDs (D. Pati, Harvey, & Pati, 2014). This research examines and measures the impact of two interior and environmental design modifications on ED Efficiency. The objective of this research is to measure and evaluate following healthcare planning solutions that, based on the literature, may potentially improve efficiency in EDs:

  1. Creating separate routes for different acuity levels known as “split flow”.
  2. Creating one way traffic and separating ED entry from exit and creating “sub-waiting” areas (D. Pati et al., 2014). Among multiple indicators that measure "Efficiency" in EDs, this study measure three efficiency metrics: (1) door to doctor time, (2) door to discharge time (length of stay) measured by time, and (3) bed utilization rate. As the method for this study, experiment model of two current emergency departments in ARENA software were created. Using data from two ED sites, the base models was validated for robustness. Design interventions were applied on the base model. Door to doctor time, length of stay, and bed utilization rates were compared and analyzed for statistical significance and effect size, between the base and modified models. The result shows that the three performance metrics: (1) door to doctor time, (2) total length of stay, and (3) bed utilization were significantly better in the simulated split flow, and internal waiting area models compared to the base ED process. The scenario analysis of different configurations of independent variables including split flow and internal waiting areas shows that the effect size of combination model is greater than the impact of individual variables in both EDs. Therefore, less door to doctor time and length of stay, and more bed utilization rate is reported when both split flow and sub-waiting areas are implementing in ED models. This study provided evidence that the impact of split flow in combination with creating internal waiting areas may significantly enhance ED efficiency. The results of this study offer novel opportunities to understand the impact and interaction of physical design solutions (split flow and sub-waiting area) in the context of efficiency improvement. In contrast to prior, mostly descriptive studies which analyze only a single factor for a given ED, this study provided broader generalizability in comparison to earlier studies by examining four different flow-design across 2 different ED sites. By evaluating the interaction of physical design and flow models, this study emphasizes the need for solutions that account for both variables.
Emergency department, Efficiency, Design