A modular simulation study to improve patient flow to inpatient units in the emergency department

Norouzzadeh, Shaghayegh; Garber, Joseph; Longacre, Melonie; Akbar, Salaahuddin; Riebling, Nancy; Clark, Robin

doi:10.5430/jha.v3n6p205

Cited by 10 publications

(6 citation statements)

References 34 publications

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“…A recent overview in [17] outlines this variety in terms of resulting research questions. Many of the existing papers in this area study reasons for excessive patient waits and discuss strategies to overcome crowded emergency departments [25,30,34,36]. Patient flows and overcrowding of departments appear to be common themes in recent years [12], both of which resonate with the purpose of our work.…”

Section: Pathway Redesign In Emergency Departmentssupporting

confidence: 57%

Redesigning the diagnostic pathway for chest pain patients in emergency departments

Rachuba

Salmon

Zhelev

et al. 2017

Health Care Manag Sci

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Patients presenting with chest pain at an emergency department in the United Kingdom receive troponin tests to assess the likelihood of an acute myocardial infarction (AMI). Until recently, serial testing with two blood samples separated by at least six hours was necessary in order to analyse the change in troponin levels over time. New high-sensitivity troponin tests, however, allow the inter-test time to be shortened from six to three hours. Recent evidence also suggests that the new generation of troponin tests can be used to rule out AMI on the basis of a single test if patients at low risk of AMI present with very low cardiac troponin levels more than three hours after onset of worst pain. This paper presents a discrete event simulation model to assess the likely impact on the number of hospital admissions if emergency departments adopt strategies for serial and single testing based on the use of high-sensitivity troponin. Data sets from acute trusts in the South West of England are used to quantify the resulting benefits.

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Section: Pathway Redesign In Emergency Departmentssupporting

confidence: 57%

Redesigning the diagnostic pathway for chest pain patients in emergency departments

Rachuba

Salmon

Zhelev

et al. 2017

Health Care Manag Sci

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“…Although physician-to-patient ratio determines the exact impact, increased staffing allows patients to stay for more thorough testing and treatment and more accurate determination of whether and when they should be admitted. Paul and Lin (2012) showed that adding one physician to the ED can significantly reduce overcrowding to positively affect care (Norouzzadeh et al, 2014).…”

Section: Resultsmentioning

confidence: 99%

Does Hospital Status Affect Performance?

Paul

Quosigk

MacDonald

2019

Nonprofit and Voluntary Sector Quarterly

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This article investigates the impact of hospital profit status on quality of care as measured by risk-adjusted, 30-day, inpatient readmission rates gathered by the Centers for Medicare and Medicaid Services. It also evaluates the association between inpatient readmission rates and market concentration, measured by the Herfindahl–Hirschman Index, and various hospital characteristics. It concludes that nonprofit (NP) hospitals have a statistically significant negative association with readmission rates because they can focus on their mission without intense pressure to make a profit. We find no significant association between quality of care and hospital market competitiveness nor any statistically significant evidence to reject the exogeneity assumption of NP status.

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“…[18] Workflow improvements have proven to be efficient if they are implemented simultaneously. [19] Gayathri and Klein studied case management as one way to reduce ED visits by FUs and found a reduction of ED use. Other strategies used to affect ED utilisation by FUs were individualised care plans, patient education, primary care partnerships and managed care level interventions.…”

Section: A Challenge To Improve Ed Servicesmentioning

confidence: 99%

Characterising double frequent users in an emergency department

Raidla

Dárro

Carlson

et al. 2018

JHA

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Visits by frequent users (FUs) has been suggested as one reason for crowding in emergency departments (EDs). In this article, we identified the characteristics of double frequent users (DFUs), ≥ 8 visits during 12 months in an ED during a period of six years, in one ED in Western Sweden. The primary outcome was to characterise DFUs and find common reasons for repeatedly visiting the ED. We conducted a retrospective cohort analysis on register data covering six years of all visits. The DFUs share of all visitors to the ED was not more than 0.03% (144 individuals), but their share of visits was 2.4% (1,017 visits/year). Chest pain and abdominal pain were the most common complaints. A typical DFU is male, around 50-year-old, unemployed, non-immigrant, suffering from alcohol abuse and/or mental health conditions. The results point to the need for changing strategies in ED services towards DFUs suffering from alcohol abuse and/or mental health conditions. The ED prioritises the severely ill but lacks resources and continuity for handling chronic diseases and follow-up routines.

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A modular simulation study to improve patient flow to inpatient units in the emergency department

Cited by 10 publications

References 34 publications

Redesigning the diagnostic pathway for chest pain patients in emergency departments

Redesigning the diagnostic pathway for chest pain patients in emergency departments

Does Hospital Status Affect Performance?

Characterising double frequent users in an emergency department

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