Performance Analysis And Capacity Planning Of Emergency Department

The Emergency Department (ED) is at the forefront of the healthcare work taking the important tasks of rescuing the emergency patientsand the critically ill patients. In recent years, the demand of emergencyservice in urban comprehensive hospitals expands continually. There aregreat contradictions between the growing demands and the limitedmedical resources, which causes the overcrowding of ED. Whileincreasing the emergency resources, there is great need to use theadvanced scientific management technology to optimize the patients’flow and the health care resource allocation and improve the emergencyservice level.The operating mode of the ED in our country is very different fromthat of other countries. In the EDs of foreign countries, emergencydoctors are responsible for the rescue of critical patients at the first time.Patients are sent to the ward after they have been in stable conditions.For comparison, EDs in China are not only responsible for the rescue ofcritical patients, but also taking care of them until their discharge. Theorganizational structure of ED is more complicated, which containsTriage, Register, Clinic, Examination Room, Pharmacy, EmergencyRoom, Observing Room, Emergency Ward and Intensive Care Unit.Taking the ED of a Tertiary hospital in Shanghai as the researchbackground, this paper addresses the problems of performanceevaluation, resources allocation and capacity planning in ED usingsimulation, queuing theory, mathematical programming, Markov chainand experiment design theory.The system is divided into two parts according to the differentstages of patients flow: patients’ visiting module and patients’ hospitalized module.(ⅰ) The emergency patients arriving at the ED is taken as the startingpoint and the patients leaving from the ED or moving to other areas ofhospital is taken as the ending point of patients’ visiting module. Firstly,the patients flow is described in detail. Secondly, a method of combiningthe simulation and experiment design is proposed to optimize theallocation of resources. Thirdly, a method of combining the queuingtheory and math programming is proposed to solve the capacity planningproblem.(ⅱ) To optimize the patients’ hospitalized module, the continuoustime Markov chain of the patients’ condition is built firstly. Secondly,the system performance under the current allocation of resources and thepull-push move rule is evaluated using simulation. Thirdly, the real-timeallocation of resource and the patients’ move rule are optimized by usingthe experiment design method.