A Study to Improve the Bottleneck of National Taiwan University Hospital Emergency Room Operation through System Simulation
Date Issued
2015
Date
2015
Author(s)
Tseng, Tzu-Wei
Abstract
National Taiwan University Hospital has serious problems of emergency department (ED) overcrowding. Excessive patients and their families cause emergency department lack of interior spaces, which results in poor service quality. Moreover, this problem increases the risk of hospital infection. One solution to the ED crowding is to increase output of the emergency system. Transferring patients to another hospital is a good way to increase the output for patients can receive timely medical care and save the waiting time. Therefore, the impact of transfer rate on the length of stay in ED is a good research topic. We created a computer simulation model based on observation and institutional data. And we take the indicators which were valued by National Health Insurance Administration to confirm that the simulation results match the real situation. Then we use sensitivity analysis and t test methods to investigate the impact of transfer rate on the length of stay in ED. Results show that the simulation model can effectively depict the changes of input variables. If transfer rate increases from 0.00487 to 0.006, the ratio of the patients who stay for more than 48 hours will be reduced by more than 17%. If transfer rate increases from 0.00487 to 0.007, the ratio of the patients who stay for more than 48 hours will be reduced by more than 17% and the ratio of the patients who stay more than 24 hours will be reduced slightly. If we focus on the bottleneck which is serious ED overcrowding and strengthen the implementation of transfer system, the length of stay will be substantially reduced. If the capacity of the bottleneck is limited by 50 patients, the ratio of the patients who stay for more than 48 hours will be significantly reduced by more than 45% and the ratio of the patients who stay for more than 24 hours will be reduced by more than 3%.
Subjects
System Simulation
Emergency Department
Emergency Department Crowding
Patient Transfer
Length of Stay
Type
thesis