Emergency Department (ED) congestion can be better understood by examining overall system impacts, in particular inpatient admissions and discharges. This study first investigates trends of inpatient admissions, volume of patients in the ED who have been admitted (ED “boarders”), length of stay, and bed resources of three major admitting services at our teaching institution. It was found that patients admitted to the General Internal Medicine (GIM) service constituted the majority of ED boarders by default rather than design, as GIM served as a safety net for specialty services. This study investigates operational factors that impact discharge and found that day of the week and holidays followed by team organization and scheduling are significant predictors of daily variation in discharge rates. Based on these results, next, a system dynamics computer simulation was built to test the impact of various discharge smoothing strategies on the number of ED boarders. Next, this study uses the framework and tools of system dynamics methodology to design a conceptual model of the ED boarder problem that may be used as a generalizable roadmap to create sustainable improvements in ED congestion. Finally, this study introduces a novel real time metric of hospital operational discharge efficiency- daily discharge rate – to bring focus on the underlying causes of discharge variation and help indicate opportunities for improvement.
| Identifer | oai:union.ndltd.org:TORONTO/oai:tspace.library.utoronto.ca:1807/32960 |
| Date | 05 September 2012 |
| Creators | Wong, Hannah Jane |
| Contributors | Sullivan, Pierre E. |
| Source Sets | University of Toronto |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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