Towards sustainable, efficient operations of an Emergency Department
MIT Park Center for Complex Systems
The MIT Park Center for Complex Systems has been conducting a study of how a hospital’s care delivery processes could be assessed with an initial focus on enhancing the efficiency of its Emergency Department (ED). The objectives of this study include a systems approach to assess the functional couplings of current practices and generate actionable recommendations to improve performance by reducing the complexity of the system.
Understanding complicated interdependencies, couplings, and interactions among system components is a key to solving complex problems, such as those in an ED. Our systems approach begins this task by explicitly stating functional requirements of an ED system. Then, means to achieve those functional requirements (design parameters) are identified within the system. This function-means (functional requirements – design parameters) mapping is repeated in detail for each individual functional requirement, thereby creating a high resolution, tree-like hierarchical structure. During this decomposition process, we analyze the interrelationships between the identified functions to discover the true points of interactions. The outcome of this analysis is a functional blueprint of a system that 1) lists comprehensive sets of functional requirements of the system, 2) shows the relation between high-level attributes and functional requirements 3) delineates the patterns of interactions between functional requirements.
Initial studies through a residential observation at a local, mid-size hospital results in the identification of 5 primary functional requirements for an ED: Quality, Satisfaction, Safety, Rate, and Growth. We have conducted a preliminary functional analysis of the ED and the results of this analysis show interactions between all of the key functional requirements. These interactions have since been decomposed to a more detailed level to understand the true nature of the coupling. This investigation proceeds further in order to understand the mechanisms of the interactions. The first of these mechanisms, upon which we are focusing, is patient flow.
Patient flow’s impact on the performance of the healthcare system encompasses most of the attributes. For example, maintaining proper patient flow (to have a patient in the appropriate treatment area at the time that they need the treatment) is a fundamental requirement in ensuring clinical quality. Eliminating extended waiting times for patients by smooth patient flow is a major contributing factor to patient satisfaction. Achieving optimal patient flow through dynamic variations of demand/supply is a key to maximizing access to the healthcare system. On the other hand, when patient flow is not properly managed, the system suffers due to mismatches in supply and demand. Long waits for patients to get into the system occur, compromising care quality and satisfaction. In even worse cases, the ED needs to go into an ambulance diversion state, and is forced to miss potential life-saving opportunities.
Understanding and examining ED patient flow has been carried out by creating a simple discrete- event simulation model which was used to study the interaction between the ED and the inpatient unit, and observing how this interaction relates to crowding in the ED. A more detailed simulation was then created in order to study other flow issues in the ED, such as proper usage levels for an ED Fast Track. This model will also be utilized to simulate the effect of the inpatient unit after we address key functional couplings within the current ED.
