Decreasing Lab Turnaround Time Improves Emergency Department Throughput and Decreases Emergency Medical Services Diversion: A Simulation Model

摘要: Background: The effect of decreasing lab turnaround times on emergency department (ED) efficiency can be estimated through system-level simulation models and help identify important outcome measures to study prospectively. Furthermore, such may suggest the advantage bedside or point-of-care testing how they might affect measures. Objectives: authors used a sophisticated model in place at an adult urban ED with annual census 55,000 patient visits. medical services (EMS) diversion, throughput, total length stay (LOS) was determined. Methods: Data were generated by using system dynamics analytic modeling approach 90 separate days from December 2, 2007, February 29, 2008. continuous flow, driven real-time actual data, had intrinsic error checking assume reasonable goodness-of-fit. A return complete laboratory results incrementally 120, 100, 80, 60, 40, 20, 10 minutes compared. Diversion calculation assumed EMS closure when more than patients waiting room 100% bed occupancy been reached for longer 30 minutes, as per local practice. LOS data insertion into flow stream time specific predefined gates. average accuracy four measurement channels (waiting volume, census, inpatient admit stream, discharge stream), all across 24 hours, measured comparing area under simulated curve against curve. Each channel’s summed averaged overall rating. Results: As decreased 120 number diversion (maximum 57 minimum 29 minutes), hours day (10.8 vs. 6.0 hours), percentage (63% 32%), (2.77 2.17 hours) decreased, while daily throughput (104 patients) increased. All runs least 85% accurate. Conclusions: This suggests compelling improvement time. Outcomes LOS, represent but understudied areas that should evaluated EDs consider processes will improve time, testing, obtain these goals. ACADEMIC EMERGENCY MEDICINE 2008; 15:1130‐1135 2008 Society Academic Emergency Medicine