Factors impacting patient flows in the emergency department

Abstract

Purpose – Emergency departments (EDs) are essential to hospital operations, involving complex processes and interactions with several hospital departments. As the entry point for many patients, EDs often face challenges such as overcrowding, staffing shortages and disruptions to patient flow, all of which negatively impact patient satisfaction. This paper aims to use discrete-event simulation and lean healthcare to analyse patient flows, exploring multiple scenarios to improve both patient experience and operations management. Design/methodology/approach – Researchers combined Lean principles with discrete-event simulation to model the entire patient flow through the ED and its interactions with other hospital departments. Various scenarios were simulated to explore potential improvements in resource allocation, inpatient admissions and reductions in non-urgent cases. Findings – This study demonstrates that reducing wait times for inpatient admissions significantly decreases all ED patients’ average length of stay (ALOS). Furthermore, reducing the number of non-urgent patient admissions has a substantial impact on ED metrics, as these patients represent over 40% of admissions and consume significant resources. Overall, combining all improvements led to a reduction in ALOS by more than 30%. Originality/value – This paper uses simulation to characterise ED operations and assess the influence of other hospital departments on patient flow. This approach provides a quantitative understanding of the role these departments play in ED overcrowding. In addition, this study compares different patient workflow characteristics and their effects, highlighting the importance of workflow decisions in shaping patient experiences.