Patient Streaming as a Mechanism for Improving Responsiveness in Emergency Departments
Patient Streaming as a Mechanism for Improving Responsiveness in Emergency Departments
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DOI：
10.2139/ssrn.1911856
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发表时间：
2012-03
期刊：
影响因子：
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通讯作者：
S. Saghafian;W. Hopp;M. P. Oyen;Jeffrey S. Desmond;S. Kronick
中科院分区：
文献类型：
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作者：
S. Saghafian;W. Hopp;M. P. Oyen;Jeffrey S. Desmond;S. Kronick
急诊科危机级别的过度拥挤状况促使医院寻求新的病人流程设计，以提高响应能力和安全性。在急诊医学界，有一种方法引起了人们的注意并进行了试验，那就是建立一个系统，在这个系统中，急诊科的病床和护理团队是分开的，根据对病人是否出院或入院的预测，对他们进行“分流”。在本文中，我们使用分析和仿真模型的组合来确定这种流策略是否可以提高ED性能，它最有可能有效的地方，以及应该如何实现最大性能。我们的研究结果表明，流的概念确实可以改善病人的流动，但只是在某些情况下。首先，ED资源必须跨流共享，而不是物理分离。这导致我们提出了一种新的“虚拟流”的急诊科病人流程设计。其次，这种类型的流媒体在急诊科最有效，1 .住院患者比例高，2 .住院患者的护理时间比出院患者长，3 .住院患者百分比的日常变化很大，4 .患者住院时间长，例如，由医院“床位阻塞”引起的，5 .平均医生利用率高。最后，为了充分利用流，负责接收病人的医生应该优先考虑上游的新病人，而负责出院病人的医生应该优先考虑下游的老病人。
Crisis-level overcrowding conditions in emergency departments EDs have led hospitals to seek out new patient-flow designs to improve both responsiveness and safety. One approach that has attracted attention and experimentation in the emergency medicine community is a system in which ED beds and care teams are segregated and patients are “streamed” based on predictions of whether they will be discharged or admitted to the hospital. In this paper, we use a combination of analytic and simulation models to determine whether such a streaming policy can improve ED performance, where it is most likely to be effective, and how it should be implemented for maximum performance. Our results suggest that the concept of streaming can indeed improve patient flow, but only in some situations. First, ED resources must be shared across streams rather than physically separated. This leads us to propose a new “virtual-streaming” patient flow design for EDs. Second, this type of streaming is most effective in EDs with 1 a high percentage of admitted patients, 2 longer care times for admitted patients than discharged patients, 3 a high day-to-day variation in the percentage of admitted patients, 4 long patient boarding times e.g., caused by hospital “bed-block”, and 5 high average physician utilization. Finally, to take full advantage of streaming, physicians assigned to admit patients should prioritize upstream new patients, whereas physicians assigned to discharge patients should prioritize downstream old patients.