Effects of bed configurations at a hospital emergency department

Abstract

This paper analysed and optimised the patient flow of a public hospital emergency department (ED). The simulation model enabled a detailed analysis of variables in the system without the chaos and potential risk that physical changes to the ED would have resulted in. The main performance indicator used throughout the study was compliance with national waiting time standards. The performance of the ED had substantial increases with balancing the utilisation of physicians, treatment areas and critical bed levels. In addition, an optimisation model was built to optimise various aspects of the multi-criteria objectives with a focus on minimising tardiness, number of tardy jobs, weighted percentage tardy jobs and waiting time in the queue. Positive results included an increase in waiting time performance with adjustments to shift allocations and important evaluations of current policies and resources. Performances were increased significantly by the solutions of the optimisation model, particularly when there was a small relaxation of the number of resuscitation beds in exchange for a combination of acute and subacute treatment areas, still ensuring space and cost constraints are met.