EAGER: Improvability Theory for Hospital Emergency Department: A System-Theoretic Method to Reduce Crowding

Emergency departments (ED) in hospitals across the nation are crowded. The number of EDs is decreasing. while patient volume is rising. Crowding not only results in delayed treatment and long patient waiting times, but also leads to overburdened staff and the resulting medical errors, high turnover. ambulance diverting. and loss of revenues for hospitals. Thus, analysis and improvement of ED processes are of significant importance. However, the applicability of the existing simulation and queueing theory methods is limited due to long model development and simulation times and lack of sophistication, respectively. Therefore, developing new analytical methods to rapidly and effectively study and improve the patient flow to reduce crowding in ED is necessary and important. The objective of this exploratory research is to establish an analytical theory of irnpro'uability for' the emergency departments. Specifically, it intends to develop methods that ('an be used to improve ED performance through redistributing limited resources and through 'dentifying and mitigating bottlenecks. These goals will be accomplished by addressing the following problems: Analysis: Analytical modeling and investigation of patient flow and quality of care (e.g,. patient outcome or length of stay) in emergency departments, and Continuous Improvement: Identifying the factors that impede ED performance in the strongest manner and obtaining optimal distribution of limited resources for the best quality of care. The approach of the research is based on analytical investigation of the stochastic processes that describe patient flow in EDs. A system-theoretic method, extended from production systems. will be used to model ED as a complex network with split, parallel, closed, and re-entrant structures, for performance analysis, bottleneck mitigation and resource allocation. The challenge of the research lies in finding appropriate characterization of the complexity in ED, discovering indicators leading to optimal system configurations, and identifying bottlenecks based on realtime data from clinical information system (CIS). The high risk of the concepts sllggested in this proposal and the high payoff of potential success make this project fit for the EAGER program. The proposed research will be carried out by a team of researchers who have been cooperating to study and improve ED efficiency for the last two years. The PI has been involved in production system research and practice for 15 years; the Co-PI has 26 years of experience in ED operations, and was the President of Emergency Nurses Association. The manufacturing expertise of the PI and the clinical experience of the Co-PI will contribute to the success of the project. The intellectual merit of this research is the establishment of novel analytical methods to study patient flow in EDs. Similar to production systems research, such methods will enable us to evaluate system performance, identify bottlenecks, distribute resources optimally and design operating policies to achieve less crowding and the best quality of care. The succesf,[ul completion of this research will lead to new methodologies for health care systems research. The broader impact of the research is in providing quantitative methods hr analysis. improvement, and operation in hospitals, clinics, and other health care facilities. The methodology is also applicable to other systems with high variability, service cost and high cost of failure, such as civil emergency response systems, critical supply chains, information networks, etc. The results obtained will be disseminated through papers, lectures and presentations and included in the courses offered by the PI. The students involved will receive significant exposure to important health care management problems and gain practical experience. Women and minority students will be actively recruited to participate, and outreach activities will be carried out for K-12 students. 1