Evaluation of physician in triage impact on overcrowding in emergency department using discrete-event simulation

Abstract

Emergency department (ED) overcrowding is a common issue in emergency medicine of Canada. Previous studies indicate that adding a physician in triage (PIT) can increase accuracy and efficiency in the initial process of patient evaluations. However, the PIT concept should be thoroughly researched before its widespread implementation can be recommended. This paper introduces the evaluation of impact of PIT on ED patient wait times and length of stay (LOS) using simulation modeling. A discrete-event simulation model of ED is built to simulate and predict the effect of PIT intervention. The model performance is validated using current-state ED flow metrics to quantitatively test multiple alternatives for ED improvements. Results show that the PIT implementation can reduce the ED patient LOS by an average of 34% and Waiting to be Seen time by 49% across all scenarios studied. The proposed method can be applied to improve the operation efficiency of healthcare systems in the current pandemic, COVID -19.

Keywords

• emergency department
• physician triage
• discrete-event simulation
• wait time