Patient Streaming as a Mechanism for Improving Responsiveness in Emergency Departments
TLDR
The results suggest that the concept of streaming can indeed improve patient flow, but only in some situations, and a new “virtual-streaming” patient flow design for EDs is proposed.Abstract:
Crisis-level overcrowding conditions in emergency departments EDs have led hospitals to seek out new patient-flow designs to improve both responsiveness and safety. One approach that has attracted attention and experimentation in the emergency medicine community is a system in which ED beds and care teams are segregated and patients are “streamed” based on predictions of whether they will be discharged or admitted to the hospital. In this paper, we use a combination of analytic and simulation models to determine whether such a streaming policy can improve ED performance, where it is most likely to be effective, and how it should be implemented for maximum performance. Our results suggest that the concept of streaming can indeed improve patient flow, but only in some situations. First, ED resources must be shared across streams rather than physically separated. This leads us to propose a new “virtual-streaming” patient flow design for EDs. Second, this type of streaming is most effective in EDs with 1 a high percentage of admitted patients, 2 longer care times for admitted patients than discharged patients, 3 a high day-to-day variation in the percentage of admitted patients, 4 long patient boarding times e.g., caused by hospital “bed-block”, and 5 high average physician utilization. Finally, to take full advantage of streaming, physicians assigned to admit patients should prioritize upstream new patients, whereas physicians assigned to discharge patients should prioritize downstream old patients.read more
Citations
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Journal ArticleDOI
Overcrowding in emergency departments: A review of strategies to decrease future challenges.
TL;DR: This study discussed strategies of team triage, point-of-care testing, ideal ED patient journey models, streaming, and fast track, in which ten interrelated substrategies are provided.
Journal ArticleDOI
An Edge Computing Based Smart Healthcare Framework for Resource Management.
TL;DR: A resource preservation net (RPN) framework using Petri net, integrated with custom cloud and edge computing suitable for ED systems is proposed, which highlights significant improvements in LoS, resource utilization and patient waiting time.
Journal ArticleDOI
Control of Patient Flow in Emergency Departments, or Multiclass Queues with Deadlines and Feedback
TL;DR: Physician capacity is modeled as a queueing system with multiclass customers, where some of the classes face deadline constraints on their time-till-first-service, whereas the other classes feedback through service while incurring congestion costs.
Journal ArticleDOI
Operations research/management contributions to emergency department patient flow optimization: Review and research prospects
TL;DR: In this paper, the influence of OR/OM on improving the performance of hospital Emergency Departments (EDs) has been discussed, including improving a wide range of processes involving patient flow from the initial call to the ED through disposition, discharge home, or admission to the hospital.
Journal ArticleDOI
Complexity-Augmented Triage: A Tool for Improving Patient Safety and Operational Efficiency
TL;DR: It is demonstrated that adding an up-front estimate of patient complexity to conventional urgency-based classification can substantially improve both patient safety and operational efficiency.
References
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Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions
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