Date of Award

11-15-2022

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

Department

Community Health Sciences

Abstract

Background: The history of emergency department (ED) as a specialty is more than 50 years now and in charge of delivering the medical and surgical services to the patient’s influx in the hospital to get served the requirement of immediate care in timely manner. ED is one of the crucial components in healthcare for bridging pre-hospital and in-hospital medical service provision. The major operational issues faced by ED includes overcrowding, long wait times, long length of stay, patient left without being seen (LWBS) and obstructed patient flow that slows down the throughput of the department. Throughput is number of patients arrived, treated, and left the unit per unit time. ED throughput is healthcare wide domain concern that is directly associated with crowding and decreased patient satisfaction due to delay in care provision and hindered flow. The low throughput of ED does not only compromise the patient satisfaction, quality of care but found to be cost impotent, since the walkouts adds to the loss of revenue for the hospital. Hence, it is necessary to identify the causes that are leading to long length of stay of ED patients and eventually the low throughput of the department, to strategize the improvement plan.
Purpose: The purpose of the study was to evaluate the ED throughput, identify the causes for congested patient flow in ED, and develop a simulation model to improve the ED throughput for reducing long length of stay (LOS), and ultimately overcrowding in the department.
Method: The study was mix method instrumental case study design. To identify the potential improvement in the ED throughput, the patient flow data was analyzed and conducted observations to assess the bottlenecks that obstructed the patient flow through the department. The use of visual aid, like process flow chart enabled to understand the patient flow. The use of Pareto chart helped to prioritize the most frequent cause of long length of stay in ED. The retrospective ED throughput database of 6 months was used to find the throughput and length of stay of the department. The data from in-hospital discharges helped to build the conceptual model to run in the simulation software to test the changes of improvement in ED throughput i.e., to assess the impact of early inpatient discharges on ED throughput.
Findings: The average length of stay (LOS) of admitted patients in ED was 10 hours 3 minutes with throughput of 100 patients per day. The conceptual model was run in the simulation software by increasing 50% early discharge orders in the hospital between 9:00 to 10:00 hours that increased the ED throughput from 100 to 101.21 patients per day by making the bed vacant early.
Conclusion: The increase in number of discharge orders early during 9:00 and 10:00 hours, has eased out the in-hospital flow by making the beds vacant early. The impact of which on the ED throughput is positive. This illustrated the importance of fostering the cross functional collaboration and its impact the on the hospital wide flow.

Comments

The advisor's name is not mentioned in the theses.

First Page

1

Last Page

125

Download

Share

COinS