Hybrid Modeling Approach to Investigate the Impact of Boarding Patients on Unit Performance

摘要

Overcrowding of Emergency Departments (EDs) is an issue that adversely affects patient safety, quality of care, and patient experience. In attempt to mitigate this risk, the National Acute Medicine Program (AMP) in Ireland has introduced a fast track medical unit, namely Acute Medical Units (AMU), designed to accommodate medical patients presenting to the ED with certain severity levels. Surprisingly, less than 50% of ED medical patients can get access to this unit. In partnership with a leading Irish hospital in Dublin, a hybrid simulation model has developed to investigate the underlying factors that limit patients' access to AMU. Discrete event simulation is used to model the process while cross-boundary interactions with other neighbor units such as ED and inpatient wards are explained using a system dynamics approach. Integrating the two simulation approaches show that boarder patients (i.e., patients waiting to progress) slow performance significantly. Decisions regarding capacity expansion are not the answer to this problem! Staffing and adequate resource leveling seem to have a better impact on patient flow.