Erin Weldon

Bio: Erin Weldon is an academic researcher from University of Manitoba. The author has contributed to research in topics: Triage & Chest pain. The author has an hindex of 9, co-authored 18 publications receiving 246 citations.

Evaluation of fast track strategies using agent-based simulation modeling to reduce waiting time in a hospital emergency department

Abstract: Different strategies have been proposed to reduce patient waiting time in hospitals. Previous investigations indicate that up to 50% or more patients can be treated in a “fast track” process compared to the standard procedure in some emergency departments. However most studies on emergency department (ED) fast tracks were based on evidence without using an efficient decision tool to show applicability of the results. An agent-based simulation tool is proposed in this research to evaluate fast track treatment (FTT) in an ED. The tool can study the behavior change of entities and resources in a complex ED system. Static and dynamic FTT processes are evaluated. The static process uses a fixed duration in the daily ED operation. In the dynamic process, FTT is triggered based on the current patient waiting time and the state of ED operations. The simulation results provide details and information for the process of the FTT implementation at the ED to reduce patient waiting time.

Bottleneck detection for improvement of Emergency Department efficiency

Abstract: Purpose – The purpose of this paper is to introduce a method of the bottleneck detection for Emergency Department (ED) improvement using benchmarking and design of experiments (DOE) in simulation model Design/methodology/approach – Four procedures of treatments are used to represent ED activities of the patient flow Simulation modeling is applied as a cost-effective tool to analyze the ED operation Benchmarking provides the achievable goal for the improvement DOE speeds up the process of bottleneck search Findings – It is identified that the long waiting time is accumulated by previous arrival patients waiting for treatment in the ED Comparing the processing time of each treatment procedure with the benchmark reveals that increasing the treatment time mainly happens in treatment in progress and emergency room holding (ERH) procedures It also indicates that the to be admitted time caused by the transfer delay is a common case Research limitations/implications – The current research is conducted in

Application of Lean principles to improve early cardiac care in the emergency department

Abstract: Objective: To achieve our goal of excellent emergency cardiac care, our institution embarked on a Lean process improvement initiative. We sought to examine and quantify the outcome of this project on the care of suspected acute coronary syndrome (ACS) patients in our emergency department (ED). Methods: Front-line ED staff participated in several rapid improvement events, using Lean principles and techniques such as waste elimination, supply chain streamlining, and standard work to increase the value of the early care provided to patients with suspected ACS. A chart review was also conducted. To evaluate our success, proportions of care milestones (first electrocardiogram [ECG], ECG interpretation, physician assessment, and acetylsalicylic acid [ASA] administration) meeting target times were chosen as outcome metrics in this before-and-after study. Results: The proportion of cases with 12-lead ECGs completed within 10 minutes of patient triage increased by 37.4% (p , 0.0001). The proportion of cases with physician assessment initiated within 60 minutes increased by 12.1% (p 5 0.0251). Times to ECG, physician assessment, and ASA administration also continued to improve significantly over time (p values , 0.0001). Post-Lean, the median time from ECG performance to physician interpretation was 3 minutes. All of these improvements were achieved using existing staff and resources. Conclusions: The application of Lean principles can significantly improve attainment of early diagnostic and therapeutic milestones of emergency cardiac care in the ED.

Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines.

Abstract: The Canadian Emergency Department Triage and Acuity Scale (CTAS) has been widely adopted in emergency departments (EDs) across Canada and abroad since its initial publication in 1999. CTAS continues to be revised and updated on a continuing basis. In 2001, a paediatric version of the CTAS implementation guidelines was developed and published. With the ongoing improvements in computer technology, the increasing demands for clinical and administrative data and the wider application of information technology in EDs, the Canadian Emergency Department Information Systems (CEDIS) committee published a standardized presenting complaint list in 2003. In 2004, a revision of the adult CTAS guidelines that incorporated the CEDIS complaint list and introduced the concept of modifiers to assist nurses in the assignment of the appropriate acuity level was published. Modifiers were divided into 2 types: first order and second order. First order modifiers are defined as modifiers that are broadly applicable to a wide number of different complaints. These include vital sign modifiers (e.g., respiratory distress, hemodynamic stability, level of consciousness and fever), pain severity (e.g., central v. peripheral and acute v. chronic) and mechanism of injury. Second order modifiers are specific to a limited number of complaints. One example of a second order modifier is low blood sugar (BS) (e.g., “BS < 3 mmol/L and/or symptomatic” is a modifier for 3 complaints, including altered level of consciousness, confusion and hypoglycemia; while “BS < 3 mmol/L and asymptomatic” modifies only 1 complaint: hypoglycemia). A CTAS revisions supplement that displayed the entire CEDIS complaint list and the relevant first and second order modifiers was published (in portable document format [PDF] and Microsoft Excel format). A more sophisticated Excel application, Complaint Oriented Triage (COT) was designed (by B.U. and M.B.) in 2007. COT, along with all CTAS publications and supplementary documents, is accessible online at www.caep.ca/template .asp?id=B795164082374289BBD9C1C2BF4B8D32. In December 2006, a new combined adult and paediatric CTAS educational package was made available to certified instructors and their students. The package is maintained on a password-protected website. Research regarding CTAS continues to be published. Studies looking at reliability and validity of CTAS using computerized decision support systems have been generally

Lean interventions in healthcare: do they actually work? A systematic literature review.

Abstract: Purpose: Lean is a widely used quality improvement methodology initially developed and used in the automotive and manufacturing industries but recently expanded to the healthcare sector. This systematic literature review seeks to independently assess the effect of Lean or Lean interventions on worker and patient satisfaction, health and process outcomes, and financial costs. Data sources: We conducted a systematic literature review of Medline, PubMed, Cochrane Library, CINAHL, Web of Science, ABI/Inform, ERIC, EMBASE and SCOPUS. Study selection: Peer reviewed articles were included if they examined a Lean intervention and included quantitative data. Methodological quality was assessed using validated critical appraisal checklists. Publically available data collected by the Saskatchewan Health Quality Council and the Saskatchewan Union of Nurses were also analysed and reported separately. Data extraction: Data on design, methods, interventions and key outcomes were extracted and collated. Results of data synthesis: Our electronic search identified 22 articles that passed methodological quality review. Among the accepted studies, 4 were exclusively concerned with health outcomes, 3 included both health and process outcomes and 15 included process outcomes. Our study found that Lean interventions have: (i) no statistically significant association with patient satisfaction and health outcomes; (ii) a negative association with financial costs and worker satisfaction and (iii) potential, yet inconsistent, benefits on process outcomes like patient flow and safety. Conclusion: While some may strongly believe that Lean interventions lead to quality improvements in healthcare, the evidence to date simply does not support this claim. More rigorous, higher quality and better conducted scientific research is required to definitively ascertain the impact and effectiveness of Lean in healthcare settings.

Application of discrete event simulation in health care: a systematic review

Abstract: The objective was to explore the current advances and extent of DES (Discrete Event Simulation) applied to assisting with health decision making, as well as to categorize the wide spectrum of health-related topics where DES was applied. A systematic review was conducted of the literature published over the last two decades. Original research articles were included and reviewed if they concentrated on the topic of DES technique applied to health care management with model frameworks explicitly demonstrated. No restriction regarding the settings of DES application was applied. A total of 211 papers met the predefined inclusion criteria. The number of publications included increased significantly especially after 2010.101 papers (48%) stated explicitly disease areas targeted, the most frequently modeled of which are related to circulatory system, nervous system and Neoplasm. The DES applications were distributed unevenly into 4 major classes: health and care systems operation (HCSO) (65%), disease progression modeling (DPM) (28%), screening modeling (SM) (5%) and health behavior modeling (HBM) (2%). More than 68% of HCSO by DES were focused on specific problems in individual units. However, more attempts at modeling highly integrated health service systems as well as some new trends were identified. DES technique has been an effective tool to approach a wide variety of health care issues. Among all DES applications in health care, health system operations research occupied the most considerable proportion and increased most significantly. Health Economic Evaluation (HEE) was the second most common topic for DES in health care, but with stable rather than increasing numbers of publications.