ED uses computer simulation to test change

Computer simulation programs are one way to determine how a planned change will impact overall operations in the ED. "It can be very helpful in allowing you to focus on what areas of change are going to produce the most improvement in patient flow," says Bruce Janiak, MD, FACEP, director of the emergency center at Toledo (OH) Hospital and former president of ACEP.

The program allows the ED to compile data such as the number of patients who arrive per hour, are triaged to minor care areas, admitted, or observed and the average turnaround time for X-ray, ECG, and lab tests. When new data are entered into the program, the effect on patient flow is revealed.

The program identifies what change has to occur to achieve specific throughput times. "You can then discuss what would happen if we added an extra nurse on the 3 p.m. to 11 p.m. shift, or somehow reduced our lab turnaround time by 15%," says Janiak. "We can plug that in and see what it does to our patient flow."

Simulating onscreen can help ED managers make decisions about change. For example, if a 30-bed department is extremely busy from 6 p.m. to midnight, and someone suggests that adding more beds is the only way to solve the problem, the computer program can test that theory, says Janiak.

"Then, if somebody else says, ‘If it didn’t take us three hours to get patients admitted, we wouldn’t need 40 beds,’ you can plug in one hour waiting for admission as opposed to three hours, and it may show you don’t need 10 more beds after all," he explains.

The ED has used the program’s data to change nurse staffing patterns to improve patient flow and implement a pneumatic tube system to transport blood to the laboratory. "Knowing the transport time would be reduced by three minutes, we could immediately predict the impact of an extension of the tube system to the ED and justify the expense," says Janiak.

Overall, the program has helped the ED to do its own internal studies. "We have shown that you look at the total turnaround time for labs, and break that down into the lab component—opening the specimen, running the test, and reporting—and the ED component—ordering the tests, drawing the blood, and transporting. Three years ago, the biggest portion of the problem was the lab. Now with the tube system, it’s the ED," says Janiak. "We know we still have problems, but we know what else we have to work on."