Improve Emergency Department (ED) Efficiency and Patient Care

The Emergency Department is a critical area within the Healthcare Industry. It is also one of the most unpredictable environments. Excessive wait times within the Emergency Department can be tolling on the patient, both physically and emotionally, while also affecting the morale of the doctors, nurses, and other medical staff.

Challenges:

Several elements can be attributed to increased patient wait times. These elements include variability in patient arrival times, poor patient flow due to check-in procedures/architectural planning, and resource contentions causes by a lack of medical staff or poorly allocated resources. These circumstances (and others) can have severe implications on an ED, leading to poor patient and staff morale, inadequate patient tracking, medical error and confusion, decreased patient wellbeing, reduced throughput, and increased operating costs.

The key to accurately planning for and anticipating the impact of variability on the Emergency Department will be to identify a solution that maintains the relationship of each entity within the Department, while increasing efficiency, accuracy and patient care.

This white paper on Emergency Department efficiency from CreateASoft will provide you with an understanding of how the ED can benefit from dynamic process simulation while providing the questions you should be asking before deciding on a solution.

Evaluating Emergency Department Solutions

There are many features and capabilities to take into account when evaluating an optimization solution for an Emergency Department. The following are some key aspects that would be required in a robust solution.

What should your Emergency Department optimization solution be capable of?

• Identifying areas of congestion within the Emergency Department for patients and staff and their contributing factors
• Determining optimal staffing levels
• Identifying the tipping point from a patient capacity perspective
• Providing patient analysis and optimization capabilities
• Optimizing patient flow and staff utilization
• Identifying optimal sizing of the facility to account for varying patient demand
• Optimizing layout and travel routes for patients and resources
• Presenting scenario comparison graphs, charts, and data
• Working for you, not against you

Consider a solution that allows for:

• Dynamic, “On-The-Fly” Interaction
• Integrated Scenario Analysis
• Run Time I/O Connectivity
• Scale-ability/Expand-ability
• Patient Arrival and Staff Scheduling
• No-Code Model Building

Optimizing the Emergency Department

With multiple potential and competing goals to work towards, one must ensure that each individual goal contributes positively to the overall Emergency Department efficiency, while at the same time not shifting problems from one area to another. The following are potential improvement opportunities from an optimization perspective for which a dynamic simulation solution will provide analysis and recommendations:

• Staffing and labor scheduling to optimize available resources, including holiday schedules
• Facility layout and design
• Patient flow, choke points, and congestion at registrations stations, examination rooms, x-ray rooms, etc.
• Capacity Analysis - Current State & Future State Forecast
• Faculty and Patient Management - Tracking & Trace-ability
• Visibility
• System Variability

Often times when working towards improving individual aspects of the operation, it is difficult to identify not only the impact on other areas of the operation but the net impact on overall efficiency gains. This is most prevalent in static analysis tools such as Excel, or in other words tools that fail to take into account the dynamics of the inter-related process, patients, doctors, nurses, other staff members and system variability.

Definition:

Dynamic Simulation allows not only for the relationship between entities to be maintained, but also for an immersive and interactive scenario development and opportunity testing environment. This allows the user to interact with the virtual environment and test, “on-the-fly,” any and all changes to layout, processes, patients, medical staff, profiling, scheduling, and virtually any change you can think of that may have a positive impact on the operation without the risk and cost of testing different scenarios in a live environment.

Model Building:

Typically, a CAD layout in either 2D or 3D will be imported. Next, processes, travel paths, timing parameters, and other defined data are input into the model. Models are built graphically, without code. This is an important distinction between traditional and dynamic simulation environments. Patient arrivals times, patient timings based on diagnosis, patient pathways, etc. can be defined in real-time from external data sources by pulling historical patient data, routing, staffing, and any other relevant data to the model from patient medical records and other external data sources. Utilizing historical data delivers upwards of 98% accuracy, while at the same time delivering apples-to-apples comparisons of current and future states based on proposed changes. Integrated optimization, analysis, 2D and 3D visualization along with the ability to create the model or virtual environment all without writing code make a dynamic simulation environment the perfect solution from an Emergency Department optimization perspective.

Benefits:

Dynamic simulation instantly provides, through integrated reporting and scenario analysis, feedback on efficiency gains at the point of attack, as well as how the change propagates throughout the system. Users can strategize about how the operation will change based on patient variability, react to different demands of staff members, and how changes in department layouts affect patient flow. A dynamic simulation solution benefits the ED in the respect that as patient arrivals and demands vary, the system can be used to mitigate any issues before they manifest within the department. Additionally, dynamic simulation benefits the ED in terms of allowing for a multitude of changes to the system in a virtual environment where the user does not have the extensive costs associated with trial and error, or the lengthy time-consuming process of utilizing excel sheets, for example. Additionally, dynamic simulation is scalable to allow for fully developed models of not only the internals of the ED, but also the entire hospital or healthcare center.

Dynamic simulation is a viable and accurate tool used in understanding current constraints, identifying effects of process changes, and visualizing and communicating the impact of moving from current to future states.

Limitations and Issues with Traditional Simulation

While there are numerous options on the market for simulation software to evaluate, it is important to note that many simulation vendors are careful to present their solution as an easy to use implementation. Promising the world and failing to deliver is a common experience in traditional tools due to the inherent limitations of the traditional technology and extensive C++, C#, or custom scripting requirements to achieve an accurate model of the operation. Pretty pictures may look good but the time it takes to build an accurate model, optimize, and analyze scenarios in most cases lead to long development times, and projects that go on for months with no end in sight.

Advantages and Benefits of a Dynamic Simulation Environment

• No-code model building
• Real-time connectivity with external data sources to ensure accurate calculation.
• Interactive “on-the-fly” model changes

• How do I go about making changes to the system?
• Do I have to stop the model every time I want to make a change? Can you show me how, with a fresh model?
• From a new model, can I see the analysis and comparison between current and future states?
• How can I account for the variability in patient types and arrival times?

With the economy as it is, and funds being more closely scrutinized before spending authorization, it is imperative that one understands the different capabilities and advantages of Simcad Pro's patented dynamic simulation software in helping to improve Emergency Department efficiency and patient care.