In health care, a widespread crisis of emergency department crowding has arisen from increasing patient demand and diminishing bed capacity. Predictable fluctuations in patient demand suggest that dynamic resource mobilization may allow for efficient, just-in-time allocation of personnel and beds; this strategy, however, would require a method to forecast near-future crowding. The dissertation presents techniques from queuing theory and discrete event simulation that enable accurate forecasting of emergency department operating conditions. A systematic review of the literature described the causes, effects, and solutions of emergency department crowding, revealing that several measures have been proposed to measure crowding, although none have been validated for the purpose of real-time forecasting. An independent, prospective validation of four previously published crowding measures indicated that three of them accurately discriminate present ambulance diversion, but none of them reliably forecast future ambulance diversion. A discrete event simulation, named ForecastED, was developed to mimic the process of patient flow through the emergency department, such that a single model could forecast many different outcome measures. A prospective evaluation of the ForecastED system demonstrated that the model provides reliable, real-time forecasts of seven different measures of crowding up to eight hours into the future. This technology may provide a foundation for health care providers to coordinate and avoid potentially dangerous crowding situations.
| Identifer | oai:union.ndltd.org:VANDERBILT/oai:VANDERBILTETD:etd-09282007-101848 |
| Date | 04 October 2007 |
| Creators | Hoot, Nathan Rollins |
| Contributors | Ian Jones, Larry LeBlanc, Chuan Zhou, Cindy Gadd, Dominik Aronsky |
| Publisher | VANDERBILT |
| Source Sets | Vanderbilt University Theses |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.vanderbilt.edu//available/etd-09282007-101848/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to Vanderbilt University or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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