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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.
Pediatr Emerg Care. 2009 Mar; 25(3):160-3.PE

Abstract

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.

Authors+Show Affiliations

Division of Emergency Medicine, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada. ghung@cw.bc.caNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19262424

Citation

Hung, Geoffrey R., and Niranjan Kissoon. "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." Pediatric Emergency Care, vol. 25, no. 3, 2009, pp. 160-3.
Hung GR, Kissoon N. 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. Pediatr Emerg Care. 2009;25(3):160-3.
Hung, G. R., & Kissoon, N. (2009). 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. Pediatric Emergency Care, 25(3), 160-3. https://doi.org/10.1097/PEC.0b013e31819a7e20
Hung GR, Kissoon N. 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. Pediatr Emerg Care. 2009;25(3):160-3. PubMed PMID: 19262424.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Hung,Geoffrey R, AU - Kissoon,Niranjan, PY - 2009/3/6/entrez PY - 2009/3/6/pubmed PY - 2009/8/28/medline SP - 160 EP - 3 JF - Pediatric emergency care JO - Pediatr Emerg Care VL - 25 IS - 3 N2 - 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. SN - 1535-1815 UR - https://www.unboundmedicine.com/medline/citation/19262424/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_ L2 - https://doi.org/10.1097/PEC.0b013e31819a7e20 DB - PRIME DP - Unbound Medicine ER -