Story of ED Flows without Separate Areas

Simplest ED Model for Daily ED Performance with 1 ED area rather than 2 in IM-10571. Currently runs over a weekend and calibrated roughly to Weekend Data.Ward net discharges are extended in IM-12414. This insight IM-11936 is the Master Version with the story added. The previous running model, now without a story, is at IM-11079

Simplest ED Model for Daily ED Performance with 1 ED area rather than 2 in IM-10571. Currently runs over a weekend and calibrated roughly to Weekend Data.Ward net discharges are extended in IM-12414. This insight IM-11936 is the Master Version with the story added. The previous running model, now without a story, is at IM-11079
<!--[if gte mso 9]> Normal 0 false false false EN-AU X-NONE X-NONE MicrosoftInternetExplorer4 <![endif][if gte mso 9]> <![endif][if gte mso 10]> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} <![endif]-->The main purpose of this model is to explore: "What would happen if we had two rather than one Emergency Physician on the Saturday day shift?"
Introduction:
The PURPOSE of ED is to focus on ED care.

The JOB of ED is to treat undifferentiated patients across age and disease or injury spectra, to create a time-restricted assessment of the patient, to resuscitate and stabilize in order to establish initial or definitive treatment, and to discharge the patient to an appropriate facility in a safely manner.
Once ED Care is completed, patients are either discharged or admitted to hospital.
Discharged patients may re-present for one of the following reason:
1. Did not wait for treatment but the condition deteriorates;
2. Patient has an exacerbation/complication of the original condition;
3. Develops a new condition/new symptoms
What happens when time delays do occur?

A number of things...

  1. Detected  delays (after Four hours- indicated by the orange arrows) can be caused by ED staff not seeing the patient on time; this may result in the patient leaving without being seen; or
  2. There can be delays in placing the patient in the appropriate treatment area; or
  3. Patients are treated and discharged late (that means after Four hours; these are represented by orange arrows)= "cl" means "Care late" and "dl" means "Disposition late".
  4. Undetected delays (not included in this model) may occur when patients are delayed but treated and discharged within the NEAT target of Four hours (blue arrows); or
After admission, patients can be transferred to:

  1. An Emergency Medical Unit (EMU) and discharged soon after; or 
  2. Remain at EMU for more than 24 hours and then discharged late or admitted late to an inpatient ward (orange arrows); or
  3. Admitted to an Inpatient ward and then discharged later on.
What does influence patient flow?
PRE TRIAGE STAGE:
  1. Daily arrivals (this is assumed to be at a constant rate) and Hour of day (time of presentation).
  2. Arrival fraction and ambulance fraction (Green) are calculated to present a continual flow of presentations to ED.
  3. These are associated with Time in pretriage and Time in preCare which decrease the Time left for care.
Flow of patients seen in ED
  • ED Spaces; and Unoccupied ED spaces increase flow while ED wait time decreases the flow of patients seen in ED;
  • ED wait time also increases time in preCare and decreases time left for care.

Others factors affecting the ED rate of patients being seen include:
  • ED completion rate
  • Factors associated with Specialists providing care, and
  • Factors related to target time in ED.
Delays to ED Care 4+ have a number of unplanned effects such as:
  1. Reducing the number of Unoccupied ED spaces;
  2. Time left for ED care is reduced;
  3. Time in PreCare is increased;
  4. The number of hours beyond target is not monitored nor controlled.
  • NEAT targets by hour are calculated to monitor the performance of ED Care.
  • Care to Disposition (blue arrow) can be affected by Total ED Disp and NEAT Target by hour.
Post ED Care:

This is an important component of the ED Care process, although it happens beyond the domain of EDs. This include delays in EMU 1+ and Impatient Wards. They affect:
  • Bed capacity, which reduces the flow from ED to IPW;
  • Occupancy ratios and NEAT targets are also affected by the number of Base specialist per hour
The next step is to explore what would happen after admission in two different scenarios on Saturday day shift:

1. With One EM Physician; or

2. Two EM physicians.
<!--[if gte mso 9]> Normal 0 false false false EN-AU X-NONE X-NONE MicrosoftInternetExplorer4 <![endif][if gte mso 9]> <![endif][if gte mso 10]> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman","serif";} <![endif]-->Finally,
  • The next step is to add the two areas with two queues and two sources (amb and WI).
  • The problem is how to allocate patients and resources to the two queues and areas and get data to calibrate it..

View the model in Insight Maker