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Journal ArticleDOI

Evaluation of physician in triage impact on overcrowding in emergency department using discrete-event simulation

01 Aug 2020-Vol. 5, Iss: 4, pp 211-226
TL;DR: Results show that the PIT implementation can reduce the ED patient LOS by an average of 34% and Waiting to be Seen time by 49% across all scenarios studied and can be applied to improve the operation efficiency of healthcare systems in the current pandemic.
Abstract: Emergency department (ED) overcrowding is a common issue in emergency medicine of Canada Previous studies indicate that adding a physician in triage (PIT) can increase accuracy and efficiency in the initial process of patient evaluations However, the PIT concept should be thoroughly researched before its widespread implementation can be recommended This paper introduces the evaluation of impact of PIT on ED patient wait times and length of stay (LOS) using simulation modeling A discrete-event simulation model of ED is built to simulate and predict the effect of PIT intervention The model performance is validated using current-state ED flow metrics to quantitatively test multiple alternatives for ED improvements Results show that the PIT implementation can reduce the ED patient LOS by an average of 34% and Waiting to be Seen time by 49% across all scenarios studied The proposed method can be applied to improve the operation efficiency of healthcare systems in the current pandemic, COVID-19 (C) 2020 by the authors;licensee Growing Science, Canada

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Citations
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Journal ArticleDOI
TL;DR: In this article, the authors identified 231 papers focused on discrete-event simulation (DES) modeling in healthcare, sorted by year, approach, healthcare setting, outcome, provenance, and software use.
Abstract: Discrete-event simulation (DES) is a stochastic modeling approach widely used to address dynamic and complex systems, such as healthcare. In this review, academic databases were systematically searched to identify 231 papers focused on DES modeling in healthcare. These studies were sorted by year, approach, healthcare setting, outcome, provenance, and software use. Among the surveys, conceptual/theoretical studies, reviews, and case studies, it was found that almost two-thirds of the theoretical articles discuss models that include DES along with other analytical techniques, such as optimization and lean/six sigma, and one-third of the applications were carried out in more than one healthcare setting, with emergency departments being the most popular. Moreover, half of the applications seek to improve time- and efficiency-related metrics, and one-third of all papers use hybrid models. Finally, the most popular DES software is Arena and Simul8. Overall, there is an increasing trend towards using DES in healthcare to address issues at an operational level, yet less than 10% of DES applications present actual implementations following the modeling stage. Thus, future research should focus on the implementation of the models to assess their impact on healthcare processes, patients, and, possibly, their clinical value. Other areas are DES studies that emphasize their methodological formulation, as well as the development of frameworks for hybrid models.

18 citations

Proceedings ArticleDOI
02 Dec 2020
TL;DR: In this paper, the authors propose an approach to resolve the congestion by recoding patient waiting time as a sign for service quality and choose quality function deployment (QFD) in resolving this case to correspond the Tunisian reality.
Abstract: Health establishment seek to provide patients with the best possible service. Improving the reception and care of patients is the ambition of all emergency departments in care facilities. The mission of the Emergency Department (ED) is to provide a medical assessment and appropriate treatment to any person in distress, in practice for any matter that arises. It is interesting for hospitals to talk about the logistics involved in material flow management and the logistics involved in patient flow management. The performance of the hospital is deeply joined to the overall performance of the services that make it up, in particular the emergency department. Managing patient flow at the emergency department level is one of the most important issues to be controlled by hospital branches. The random arrival of patients in the emergency department is the particularity of the latter compared to other departments of the hospital. The length of stay at the emergency reception is one of the daily problems of these services, such as the increase in emergency room admissions exceeding day-to-day care capacity has led services to organize themselves to improve their performance and thus increase the number of patients treated and decrease the stay. In this work, we propose an approach to resolve the congestion by recoding patient waiting time as a sign for service quality. We choose quality function deployment (QFD) in resolving this case to correspond the Tunisian reality.

2 citations

Proceedings ArticleDOI
07 Oct 2020
TL;DR: The challenges faced by the clinical staff during the usage of previous POCT and the implementation process are discussed to give a clear clarification about the essentiality of the developed framework of POCT.
Abstract: Point-of-Care Test (POCT) is considered as the diagnostic test which is administrated in the outside of the central laboratory ator near the patient location. Therefore, it can be stated that the use of POCT devices in the department of emergency represents a significant benefit to the management of the patient. It can be able to give proper governance to credible policy, safe practice, and effective process performance by the healthcare clinics. The major contribution of the POCT is it can give a huge improvement over the test result in the context of turnaround time. Here this research paper considers the process of development framework of POCT in the emergency department (ED). Moreover, the challenges faced by the clinical staff during the usage of previous POCT and the implementation process are also discussed to give a clear clarification about the essentiality of the developed framework of POCT.

2 citations

References
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Journal ArticleDOI
TL;DR: A structured overview of the literature may help to identify future directions for the crowding research agenda and provide valuable contributions toward better understanding and alleviating the daily crisis.

1,329 citations


"Evaluation of physician in triage i..." refers background in this paper

  • ...Multiple solutions to alleviate ED overcrowding have been studied in literature including the demand management in non-urgent patient referrals, ambulance diversion and destination control, additional resources either physical or human, and operations research to provide business intelligence for the patient flow optimization (Hoot and Aronsky, 2008)....

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  • ...…studied in literature including the demand management in non-urgent patient referrals, ambulance diversion and destination control, additional resources either physical or human, and operations research to provide business intelligence for the patient flow optimization (Hoot and Aronsky, 2008)....

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  • ...A comprehensive review concluded that common effects of ED overcrowding include the patient mortality, transport delays, treatment delays, ambulance diversion, patient elopement, and financial effect (Hoot & Aronsky, 2008; Higginson, 2012)....

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Journal ArticleDOI
TL;DR: The goal of the conceptual model is to provide a practical framework on which an organized research, policy, and operations management agenda can be based to alleviate ED crowding.

790 citations


"Evaluation of physician in triage i..." refers background in this paper

  • ...Although factors causing overcrowding penetrate in almost every level of an ED system, the mismatch between the supply and demand devotes its major contribution to this issue (Asplin et al., 2003)....

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Journal ArticleDOI
01 Jun 2011-BMJ
TL;DR: Presenting to an emergency department during shifts with longer waiting times, reflected in longer mean length of stay, is associated with a greater risk in the short term of death and admission to hospital in patients who are well enough to leave the department.
Abstract: Objective To determine whether patients who are not admitted to hospital after attending an emergency department during shifts with long waiting times are at risk for adverse events. Design Population based retrospective cohort study using health administrative databases. Setting High volume emergency departments in Ontario, Canada, fiscal years 2003-7. Participants All emergency department patients who were not admitted (seen and discharged; left without being seen). Outcome measures Risk of adverse events (admission to hospital or death within seven days) adjusted for important characteristics of patients, shift, and hospital. Results 13 934 542 patients were seen and discharged and 617 011 left without being seen. The risk of adverse events increased with the mean length of stay of similar patients in the same shift in the emergency department. For mean length of stay ≥6 v Conclusions Presenting to an emergency department during shifts with longer waiting times, reflected in longer mean length of stay, is associated with a greater risk in the short term of death and admission to hospital in patients who are well enough to leave the department. Patients who leave without being seen are not at higher risk of short term adverse events.

575 citations


"Evaluation of physician in triage i..." refers background in this paper

  • ..., 2007), associated with a great risk in patient safety and mortality (Guttmann et al., 2011; Carter et al., 2014)....

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  • ...A national level survey conducted by the Canadian Agency for Drugs and Technology in Health reported that 62% of ED directors regarded overcrowding as a severe problem (Bond et al., 2007), associated with a great risk in patient safety and mortality (Guttmann et al., 2011; Carter et al., 2014)....

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  • ...The adverse effects of prolonged wait times include the patient dissatisfaction and safety concerns (Bond et al., 2007; Guttmann et al., 2011; Carter et al., 2014)....

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Journal ArticleDOI
TL;DR: This work discusses why specificity dominates and why more generic approaches are rare in the DES literature, and classify papers according to the areas of application evident in the literature, discussing the apparent lack of genericity.
Abstract: Discrete Event Simulation (DES) has been widely used in modelling health-care systems for many years and a simple citation analysis shows that the number of papers published has increased markedly since 2004. Over the last 30 years several significant reviews of DES papers have been published and we build on these to focus on the most recent era, with an interest in performance modelling within hospitals. As there are few papers that propose or illustrate general approaches, we classify papers according to the areas of application evident in the literature, discussing the apparent lack of genericity. There is considerable diversity in the objectives of reported studies and in the consequent level of detail: We discuss why specificity dominates and why more generic approaches are rare.

505 citations

Journal ArticleDOI
TL;DR: A review of the current body of academic literature is presented, with the goal of identifying select high-impact front-end operational improvement solutions.

344 citations


"Evaluation of physician in triage i..." refers background in this paper

  • ...Typically, these front-end operations include the initial patient presentation, registration, triage, bed placement, and medical evaluation although they may vary in different EDs as uncertain factors (Wiler et al., 2010)....

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  • ...There are multiple interventions for potential solutions to improve the ED patient flow (Oredsson et al., 2011; Wiler et al., 2010)....

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  • ...These strategies include using immediate bedding, bedside registration, tracking systems and whiteboards, wireless communication device, kiosk self-check-in and personal health record technology (Wiler et al., 2010; Kaushal et al., 2015)....

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  • ...Patients would have to wait in a queue because of their non-succession occurring (Wiler et al., 2010)....

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