Optimal-Use was recently asked to analyze the impact of changes to an Emergency Department’s operations.  The department felt that by eliminating triage and adopting a Rapid Assessment Zone(RAZ) they would improve and streamline care.  Their hope was that this change would reduce long waits for care and in turn reduce patients leaving without being seen.     While convinced this concept would improve care, they needed to test their hypothesis.   Ultimately they needed to provide justification for the process change and associated project cost. 

We worked closely with nurses, MDs and quality assurance to define the current state and then the proposed future state.  We were able to analyze several months of patient records to define ranges and variability for patient volume, arrivals, length of stay and acuity levels.   A discrete event simulation was first developed of the existing conditions.  This validated the accuracy of the model and the data used.  It formed a benchmark and basis for improvement.  The metric for performance was the number of patients in the waiting rooms.      We then developed a model based on the proposed RAZ concept.  

Simulation modeling can be used as part of an interactive design process.  By incorporating user defined variables, it is possible to quickly test various scenarios with the impact of changes immediately understood. In this case, the number of RAZ positions could be easily changed to test how waiting was impacted.

Modifying the percent of patient acuity types utilizing the RAZ unit turned out to have a significant impact on throughput.  Once a program was finalized,  it was ”stressed” to test increased volumes, and  compressed patient arrival times.   This demonstrated that while 16 rooms would work under most conditions, 18 rooms could dramatically reduce backups during a peak period.  (See diagram)Because of the existing space constraints, determining the optimal number of rooms was critical.

The results informed the design and ultimately the budget.  The department can now present their case to administration justified by analysis.