Focus your Performance Improvement efforts through Process Simulation

Boarding

Is my overcrowded ED caused by crowding in the rest of the hospital, leading to "boarders" who are held in the ED until a bed opens up in an inpatient unit?  What if admission processing time was reduced by one hour? By 2 hours? Base Hospital: 257 patients per day: 11 physicians

	Patient throughput (average)	Physician utilization
Base	4 hours 56 minutes	77%
Admit times reduced 1 hour	4 hours 24 minutes	84%
Admit times reduced 2 hours	3 hours 36 minutes	93%

Beds

 Are my physicians underutilized because there aren't enough beds? Would adding a couple of beds decrease patient time-in-system and increase physician utilization? What about a few more beds? Base Hospital: 272 patients per day: 11 physicians: 25 ED beds

	Patient throughput (average)	Physician utilization
Base	4 hours 51 minutes	77%
27 beds	4 hours 43 minutes	81%
30 beds	4 hours 25 minutes	94%
35 beds	3 hours 46 minutes	100%
Unlimited beds	3 hours 43 minutes	100%

Diversion

What's my expected loss in revenue if we have to divert patients because of overcrowding? How many patients would be diverted?  What would I have to change to reduce/ eliminate diversion? Lab or X-ray turnaround time?  Physician scheduling?  Specialist on-call response times? Base Hospital: 272 patients per day: 11 physicians: 25 ED beds: 90 minute lab/X-Ray turnaround time, Diversion Criteria: EMS arrival wait time for bed > 60 minutes or All ED beds are occupied, Diversion Duration: 2 hours

	Patient throughput (average)	Physician utilization	Diverted
Base	3 hours 08 minutes	85%	30 EMS patients
60 minutes lab/X-Ray	2 hours 43 minutes	89%	26 EMS patients
30 minutes lab/X-Ray	2 hours 32 minutes	92%	20 EMS patients
1 additional physician per shift	2 hours 08 minutes	70%	30 EMS patients
Specialist response time reduced by 50%	3 hours 07 minutes	86%	30 EMS patients

Triage Process

If I have the physician perform the initial triage, I may reduce the metric of "time to see a doctor", but what is the effect of total patient time-in- system? Shorter? Longer?  How about if the physician does both the initial triage and assessment? Would I have to increase the number of scheduled physicians? What about the metric "time to assessment?" Base Hospital: 272 patients per day: 11 physicians: 25 ED beds

	Patient throughput (average)	Physician utilization	Time to see a physician
Triage by non physician	3 hours 08 minutes	85%	1 hour 13 minutes
Triage by physician	5 hours 28 minutes	93%	1 hours 15 minutes
Triage & assess by physician	4 hours 9 minutes	100%	2 hours 2 minutes

Would I have to increase the number of scheduled physicians?  How about double? Base Hospital: 272 patients per day: 22 physicians: 25 ED beds

	Patient throughput (average)	Physician utilization	Time to see a physician
Triage by non physician	2 hours 06 minutes	46%	17 minutes
Triage by physician	2 hours 19 minutes	56%	7 minutes
Triage & assess by physician	2 hours 7 minutes	58%	9 minutes