Title: Performance comparison of four triage-based patient flow interventions in the emergency department

Authors: Yunfei He; Ting Lei; Gül E. Okudan Kremer

Addresses: Department of Industrial and Manufacturing Engineering, The Pennsylvania University, 301C Engineering Units, University Park, PA 16802, USA ' Department of Industrial and Manufacturing Engineering, The Pennsylvania University, 301C Engineering Units, University Park, PA 16802, USA ' School of Engineering Design, Department of Industrial and Manufacturing Engineering, The Pennsylvania University, 213T Hammond, University Park, PA 16802, USA

Abstract: Numerous efforts have been put forth into eliminating the adverse effects that come along with Emergency Department overcrowding, such as long waiting times, patients leaving without being seen and deterioration of quality of care. From the published patient flow improvement interventions, we focus on strategies that are widely discussed in the relevant literature: FIFO with priority, fast track, physician triage and team triage. The effectiveness of these interventions is shown through mostly observational and a limited number of controlled studies, where only a specific intervention is studied. However, these 'success stories' help little when alternatives are not compared properly. To overcome this problem, we propose a simulation approach to examine these interventions in a controlled environment and to enable the sensitivity analyses of critical ED parameters such as resources or patients' inputs. A patient risk-adjusted ED performance measurement is also proposed to guide future implementations.

Keywords: emergency departments; patient flow; triage; simulation; failure mode and effects analysis; FMEA; operational efficiency; patient risk; LWBS; leaving without being seen; accident and emergency; A&E departments; performance measurement; healthcare services.

DOI: 10.1504/IJCENT.2014.065058

International Journal of Collaborative Enterprise, 2014 Vol.4 No.1/2, pp.115 - 135

Received: 06 May 2013
Accepted: 05 Apr 2014
Published online: 09 Oct 2014 *

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