Optimizing Emergency Department Throughput

Across the country ambulances are turned away from emergency departments (EDs) and patients are waiting hours and sometimes days to be admitted to a hospital room. Hospitals are finding it hard to get specialist physicians to come to treat emergency patients. Our EDs demand a new way of thinking. They are not at a tipping point; they are at a breaking point. Under current loads and trends they are going to begin to break and these breakdowns will be painful and ultimately dangerous to society. Recognizing that the ideal in health care is presently beyond our immediate grasp, this book instead focuses on providing health care leaders with the tools they can employ to optimize the performance of EDs and thereby improve service to patients, employees, and communities. Written by 20 of the most progressive and successful health care reformers in the country, the approaches described can be utilized to quantify improvements, enhance predictability of workflow, and improve staff scheduling. The data derived using these techniques can serve as powerful evidence in support of change. While a common discussion among ED professionals is the perception that many patients are not really emergency patients and could be treated in another setting at another time, that argument is not germane until we as a nation elect to reform the way we chose to deliver healthcare to the underserviced. In the meantime this book provides invalauable information to help individual hospitals to retool their ED’s. It offers new approaches that think outside of the box for all stakeholders. It also provides the statistical evidence that administrators need to make their cases for changes and added resources. It will help you forecast the demand for services and give your center an approach that will allow the ED to become a source of income rather than one that continues to hemorrhage needed limited health care funding.

Written for a global audience, by an international team, the book provides practical, case-based emergency department leadership skills.

Today our emergency care system faces an epidemic of crowded emergency departments, patients boarding in hallways waiting to be admitted, and daily ambulance diversions. Hospital-Based Emergency Care addresses the difficulty of balancing the roles of hospital-based emergency and trauma care, not simply urgent and lifesaving care, but also safety net care for uninsured patients, public health surveillance, disaster preparation, and adjunct care in the face of increasing patient volume and limited resources. This new book considers the multiple aspects to the emergency care system in the United States by exploring its strengths, limitations, and future challenges. The wide range of issues covered includes: • The role and impact of the emergency department within the larger hospital and health care system. • Patient flow and information technology. • Workforce issues across multiple disciplines. • Patient safety and the quality and efficiency of emergency care services. • Basic, clinical, and health services research relevant to emergency care. • Special challenges of emergency care in rural settings. Hospital-Based Emergency Care is one of three books in the Future of Emergency Care series. This book will be of particular interest to emergency care providers, professional organizations, and policy makers looking to address the deficiencies in emergency care systems.

Optimizing patient flow : advanced strategies for managing variability to enhance access, quality, and safety offers readers innovate techniques for maximizing patient flow and improving operations management while providing clear examples of successful impementation. This all-new book can help health care organizations to reduce and manage variability, thereby increasing the reliablity of systems and processes and improving health care quality and safety.

In this study, we have aimed to optimize patient flow in emergency departments while minimizing associated costs. In order to be able to compare the effect of any changes, we developed a simulation model for an emergency department using Queuing theory, and regarding the optimization we utilized Genetic Algorithm to find the best change. Basically, we have designed a Discrete Event based, multi-class, multi-server queuing network as we have considered the emergency department a set of stages associated with a queue of patients waiting to be served. Each stage has multiple service providers such as Nurses, Doctors or other staff. We also classified patients passing through the stages, according to their acuity level and personal characteristics. Then, we defined a function as a measure of the ED performance in respect to the calculated wait times and the cost. Finally, we developed a customized genetic algorithm to find the best performance which reflects the best allocation of service providers into multiple stages of the emergency department.

There's never been so much opportunity for your Emergency Department to shine. These are critical days for healthcare. We know more about optimizing quality and saving lives than at any point in history. At the same time, cost pressures have never been greater. Add in higher-than-ever patient expectations and the message is clear: Hospitals that can learn to do more with less will thrive. Those that can't may not even exist a few years from now. The Emergency Department plays a pivotal role in how your hospital adapts to our new reality. This book offers a wealth of tools and tactics aimed at helping you get results more efficiently, effectively, and collaboratively. Master them and you'll improve quality, exceed patient expectations, and ultimately, help the entire organization maintain and grow its profit margin. You'll learn how to: * Diagnose flow challenges and redesign systems to make them far more efficient; * Align ED goals with other key areas and weight them to drive performance; * Hardwire advanced communication tools that calm and reassure patients, reduce LWBS rates, and minimize preventable readmissions; * Engage physicians and collaborate with hospitalists for optimal patient safety; and * Drive collaboration within the ED, the larger hospital, and the community. World-class Emergency Departments don't follow. They lead. When you commit to building and sustaining an agile, high-performing ED, you'll not only fulfill your mission of serving patients and saving lives, you'll light the way for your entire hospital to prosper in the new era.

The Annual Update compiles the most recent developments in experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in the field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediatrics, intensive care and emergency medicine.

This book is dedicated to improving healthcare through reducing delays experienced by patients. With an interdisciplinary approach, this new edition, divided into five sections, begins by examining healthcare as an integrated system. Chapter 1 provides a hierarchical model of healthcare, rising from departments, to centers, regions and the “macro system.” A new chapter demonstrates how to use simulation to assess the interaction of system components to achieve performance goals, and Chapter 3 provides hands-on methods for developing process models to identify and remove bottlenecks, and for developing facility plans. Section 2 addresses crowding and the consequences of delay. Two new chapters (4 and 5) focus on delays in emergency departments, and Chapter 6 then examines medical outcomes that result from waits for surgeries. Section 3 concentrates on management of demand. Chapter 7 presents breakthrough strategies that use real-time monitoring systems for continuous improvement. Chapter 8 looks at the patient appointment system, particularly through the approach of advanced access. Chapter 9 concentrates on managing waiting lists for surgeries, and Chapter 10 examines triage outside of emergency departments, with a focus on allied health programs Section 4 offers analytical tools and models to support analysis of patient flows. Chapter 11 offers techniques for scheduling staff to match patterns in patient demand. Chapter 12 surveys the literature on simulation modeling, which is widely used for both healthcare design and process improvement. Chapter 13 is new and demonstrates the use of process mapping to represent a complex regional trauma system. Chapter 14 provides methods for forecasting demand for healthcare on a region-wide basis. Chapter 15 presents queueing theory as a method for modeling waits in healthcare, and Chapter 16 focuses on rapid delivery of medication in the event of a catastrophic event. Section 5 focuses on achieving change. Chapter 17 provides a diagnostic for assessing the state of a hospital and using the state assessment to select improvement strategies. Chapter 18 demonstrates the importance of optimizing care as patients transition from one care setting to the next. Chapter 19 is new and shows how to implement programs that improve patient satisfaction while also improving flow. Chapter 20 illustrates how to evaluate the overall portfolio of patient diagnostic groups to guide system changes, and Chapter 21 provides project management tools to guide the execution of patient flow projects.