Patient Flow Interventions and Prioritization in Emergency Department

Open Access
Author:
He, Yunfei
Graduate Program:
Industrial Engineering
Degree:
Master of Science
Document Type:
Master Thesis
Date of Defense:
April 11, 2013
Committee Members:
  • Gul Kremer, Thesis Advisor
  • Guodong Pang, Thesis Advisor
  • Dr Marija Jankovic, Thesis Advisor
Keywords:
  • ED
  • Emergency Department
  • Simulation
  • Patient Flow
  • Triage
  • Risk
  • Scheduling
  • Priority
  • Queueing
Abstract:
Emergency Department overcrowding has been a major problem in the United States for almost two decades. Accordingly, numerous efforts have been put forth into eliminating the adverse effects that come along with it, such as long waiting times, patients leaving without being seen and deterioration of quality of care. From the published patient flow improvement interventions, we focus on strategies that are widely discussed in the relevant literature: fast track, physician triage and team triage. The effectiveness of these interventions is shown through mostly observational and a limited number of relatively controlled studies, where only a specific intervention is studied. However, these “success stories” help little when alternatives are not compared properly. To overcome this problem, we propose a simulation approach to examine these interventions in a controlled environment and to enable the sensitivity analyses of critical ED parameters such as resources or patients' inputs, and performance measures. The impact on patients of different urgency level is also addressed so that generalized conclusions on the effectiveness of interventions can be made to guide future implementations.