Treatment allocation for the potential urgent patients in hospital emergency department to reduce length of stay – a simulation approach

Abstract

Extended waiting in the emergency room continues to be a recognized problem; to alleviate this many hospitals have adopted triage systems which classify patients based on their priority level and fast track processes for low acuity patients. This paper aims to reduce the length of stay in Emergency Department (ED) by allocating urgent patients in either the traditional treatment or the fast track route without compromising care for higher acuity patients. This study focuses on the five-priority level system and evaluates the concept using simulation and classification techniques. Literature has reported that priority three patients, whose conditions are initially not life threatening but may progress to a critical level, are the majority and normally encounter the longest wait. The simulation was built based on a difined ED patient flow considering factors such as patient arrival patterns, treatment times, and resource capacity. Analysis of Variance was conducted to determine the impact of each factor to the decision on level 3 patient allocation. A regression model was constructed to estimate the cycle time savings. Decision tree was used to further provide ED a general guideline on the allocation of level 3 patients. The study concludes that the fast track route as an option for level 3 patients is adequate if the fast track has higher or similar capacity as the traditional treatment route especially for the rural EDs where level 3 patients are identified 61% of time and required longer treatment. The patient cycle time saving estimated as much as three hours.