Optimizing emergency services in hospitals

A team of Iranian researchers has developed a computer simulation to measure the performance of hospital emergency departments and determine the best way to allocate their limited medical resources¹.

The emergency department is a primary healthcare unit that treats large numbers of patients. Timely treatment can save lives, but sometimes cannot be delivered owing to a lack of sufficient resources, particularly beds and qualified healthcare professionals.

Nezameddin Faghih of the University of Tehran and his colleagues visited the Persian Gulf Hospital in Bushehr, Iran, and used questionnaires and interviews to collect information about three key performance indicators: the use of resources, average patient waiting time, and patient’s total average length of stay in the emergency department.

They then used this data to develop a computer simulation model of complex care processes, including triage, diagnosis by general practitioners, and patient flow within the department.

The Persian Gulf Hospital is a teaching hospital with 280 beds and an emergency department that is open 24 hours a day, with services on each shift provided by two GPs, one specialist and three nurses, with five other nurses and more specialists on call. Patients’ average length of stay in the emergency department is six hours, due largely to lack of resources and long waiting times.

After validating their computer model, the researchers used it to compare different configurations of beds and healthcare staff in order to optimize the allocation of resources and minimize the patients’ length of stay.

According to their simulation, the department’s financial budget would allow for a new configuration of 20 inpatient beds, three nurses and one GP, which would reduce patients' average length of stay by nearly 10 minutes. A small increase in the budget would, however, allow for an additional on-site nurse and two GPs, which would lower the length of stay even further. 

The researchers note that their study was limited by the lack of cooperation from healthcare authorities, difficulties in tracing some of the patients, and lack of relevant information from emergency departments in other hospitals.

They believe, however, that their model is an improvement on earlier ones, which did not take length of stay into account, and that hospital managers could use it to evaluate and optimize resources in their emergency departments.

1. Keshtkar, L., Salimifard, K. & Faghih, N. A simulation optimization approach for resource allocation in an emergency department. QScience Connect 2015, 8 (2015). | article