COMPARATIVE STUDY
JOURNAL ARTICLE

Impact of an observation unit and an emergency department-admitted patient transfer mandate in decreasing overcrowding in a pediatric emergency department: a discrete event simulation exercise

Geoffrey R Hung, Niranjan Kissoon
Pediatric Emergency Care 2009, 25 (3): 160-3
19262424

OBJECTIVES: The primary objective was to examine the effects of a simulated observation unit (OU) and a transfer mandate for admitted patients on pediatric emergency department (PED) patient flow indicators. The secondary objective was to report on the occupancy rate of the simulated OU.

METHODS: Simulations were conducted using a previously designed and validated discrete event simulation model of our PED operations. A simulated OU was designed, and an emergency department-admitted patient transfer mandate was developed and then applied to a discrete event simulation model. Four scenarios (regular PED operations with and without a 5-bed OU and transfer mandate in all combinations) were modeled.

RESULTS: A combination of an OU and an emergency department-admitted patient transfer mandate resulted in reductions in time to be seen by a physician and length of stay in patients who were triaged with urgent or emergent presentations as compared with PED operations with neither an OU nor a transfer mandate. Small improvements in fractile response were observed for patients triaged with urgent presentations. The OU without the transfer mandate had a simulated occupancy rate of 73.1%. The inclusion of the transfer mandate reduced the occupancy rate to 48.1%.

CONCLUSIONS: Simulation scenario analyses predict that an OU and a transfer mandate would reduce overcapacity in the PED, with more substantial reductions in time to be seen and length of stay for patients of high acuity.

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