A support framework for decision making in emergency department management

Abstract

The Emergency Department (ED) management environment is complex and the highly variable demand for care in a given timeframe leads their managers to try to adjust their resources to meet the demand. Managers are usually forced to identify strategies and make decisions without effective knowledge of the actual state of processes or the impact of their decisions. However, the fact that (EDs) are run based on Medical Guidelines that define performance criteria targets contributing to delivering efficient management should be highlighted. Nonetheless, identifying improvement actions based on the criteria defined and making effective decisions is no easy task given the level of complexity of ED management environments. To this end, this paper introduces a Framework based on the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method with Discrete Event Simulation (DES) as support in devising improvement actions with a view to enhancing management performance for an ED that services patients covered by the Brazilian federal government’s single healthcare system (Sistema Único de Saúde - SUS). Deploying the DEMATEL method enabled identifying the influential and important criteria in the criteria network used to run the patient care and treatment process management and, in their turn, devising improvement actions for the ED under study. In addition, in many cases, process specialists are unaware of the concrete impacts resulting from the implementation of these actions. Therefore, the proposed Framework incorporates knowledge of the DES to test the improvement actions through simulated scenarios. This new approach (DEMATEL-DES Framework) can help establish a system for the decision-making process that, in its turn, can support ED managers in making complex decisions.