Emergency Department Structure Research Articles

Accuracy of Computer Simulation to Predict Patient Flow during Mass-Casualty Incidents

Although most hospitals have an emergency department disaster plan, most never have been implemented in a true disaster or been tested objectively. Computer simulation may be a useful tool to predict emergency department patient flow during a disaster. The aim of this study was to compare the accuracy of a computer simulation in predicting emergency department patient flow during a mass-casualty incident with that of a real-time, virtual, live exercise. History, physical examination findings, and laboratory results for 136 simulated patients were extracted from the disastermed.ca patient database as used as input into a computer simulation designed to represent the emergency department at the University of Alberta Hospital. The computer simulation was developed using a commercially available simulation software platform (2005, SimProcess, CACI Products, San Diego CA). Patient flow parameters were compared to a previous virtual, live exercise using the same data set. Although results between the computer simulation and the live exercise appear similar, they differ statistically with respect to many patient benchmarks. There was a marked difference between the triage codes assigned during the live exercise and those from the patient database; however, this alone did not account for the differences between the patient groups. It is likely that novel approaches to patient care developed by the live exercise group, which are difficult to model by computer software, contributed to differences between the groups. Computer simulation was useful, however, in predicting how small changes to emergency department structure, such as adding staff or patient care areas, can influence patient flow. Computer simulation is helpful in defining the effects of changes to a hospital disaster plan. However, it cannot fully replace participant exercises. Rather, computer simulation and live exercises are complementary, and both may be useful for disaster plan evaluation.

Emergency Medicine in West Kazakhstan, CIS

Now a member of the Commonwealth of Independent States, Kazakhstan is the second largest of the republics that made up the former Soviet Union. This report describes the structure of the health care system in Kazakhstan, with particular emphasis on emergency medicine. It examines medical education, the organization of health care services, emergency medical services, emergency department structure, and the challenges facing emergency medicine. [Partridge RA: Emergency medicine in West Kazakhstan, CIS. Ann Emerg Med October 1998;32:493-497.]

The Status of the Trauma Coordinator Position

The trauma coordinator (TC) position is a vital link in the development and operations of trauma care systems. In 1992 and 1993, the American Trauma Society conducted a national survey of TCs to describe the roles and characteristics of the persons who hold those positions. Of 354 trauma coordinators identified in 46 states, more than three-fourths were employed by large hospitals designated as trauma centers. The typical TC was a woman 26 to 59 years old who held at least a bachelor's degree in nursing. Although new as TCs (mean, 3 years as TCs), the respondents averaged 14 years experience in nursing. Both full-time and part-time TCs worked longer hours than scheduled, often had supervisory responsibilities, and generally were in the nursing administration or the emergency department structure. Most TCs worked with computerized trauma registries that were used routinely in quality of care reviews.

The Status of the Trauma Coordinator Position

The trauma coordinator (TC) position is a vital link in the development and operations of trauma care systems. In 1992 and 1993, the American Trauma Society conducted a national survey of TCs to describe the roles and characteristics of the persons who hold those positions. Of 354 trauma coordinators identified in 46 states, more than three-fourths were employed by large hospitals designated as trauma centers. The typical TC was a woman 26 to 59 years old who held at least a bachelor's degree in nursing. Although new as TCs (mean, 3 years as TCs), the respondents averaged 14 years experience in nursing. Both full-time and part-time TCs worked longer hours than scheduled, often had supervisory responsibilities, and generally were in the nursing administration or the emergency department structure. Most TCs worked with computerized trauma registries that were used routinely in quality of care reviews.