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1314 IEEE TRANSACTIONS ON SYSTEMS, MAN, AND CYBERNETICS—PART A: SYSTEMS AND HUMANS, VOL. 42, NO. 6, NOVEMBER 2012 Reducing Length of Stay in Emergency Department: A Simulation Study at a Community Hospital Junwen Wang, Student Member, IEEE , Jingshan Li, Senior Member, IEEE , Kathy Tussey, and Kay Ross Abstract —In this paper, a simulation model of an emergency department (ED) at a large community hospital, Central Baptist Hospital in Lexington, KY, is developed. Using such a model, we can accurately emulate the patient flow in the ED and carry out sensitivity analysis to determine the most critical process for improvement in quality of care (in terms of patient length of stay). In addition, a what-if analysis is performed to investigate the potential change in operation policies and its impact. Floating nurse, combining registration with triage, mandatory requirement of physician’s visit within 30 min, and simultaneous reduction of operation times of some most sensitive procedures can all result in substantial improvement. These recommendations have been submitted to the hospital leadership, and implementations are in progress. Index Terms —Discrete-event simulation, emergency depart- ment (ED), length of stay (LOS), patient flow, what-if analysis. I. I NTRODUCTION H OSPITAL EMERGENCY departments (EDs) in the U.S. are suffering from inability to accommodate increasing patient demands. According to national health statistics report [1], from 1996 to 2006, the annual number of ED visits in- creased by 30 % , from 90.3 million to 119.2 million, while the number of hospital EDs decreased by 5 % , from 4019 to 3833. Similar results are observed in other surveys as well [2], [3]. Therefore, EDs are experiencing significant challenges. As the demand for emergency care increases, the ED may dissatisfy patients with extremely long length of stay (LOS). Therefore, improving ED efficiency to reduce LOS has been a major effort in many of them. Many of the continuous improvement projects in EDs or other healthcare facilities are based on experiences and intu- itive and qualitative principles. However, such methods cannot provide a quantitative prediction of the impact of such effort and may not result in substantial improvement as one has expected. For example, which procedure should be the focus such that it will lead to the largest reduction in LOS? Does the ED need more nurses, physicians, or radiology equipment? Are there any staff scheduling policies that are superior to the Manuscript received November 4, 2010; accepted May 31, 2011. Date of current version October 12, 2012. This work was supported in part by the National Science Foundation under Grant CMMI-1063671. This paper was recommended by Associate Editor M. P. Fanti. J. Wang and J. Li are with the Department of Industrial and Systems Engineering, University of Wisconsin—Madison, Madison, WI 53706 USA (e-mail: [email protected]; [email protected]).
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  • Spring '16
  • Emergency Department, Computer simulation, patient flow

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