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Modelling granular process flow information to reduce bottlenecks in the emergency department
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Amissah, Marian and Lahiri, Sudakshina (2022) Modelling granular process flow information to reduce bottlenecks in the emergency department. Healthcare, 10 (5). 942. doi:10.3390/healthcare10050942 ISSN 2227-9032.
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WRAP-Modelling-granular-process-flow-information-to-reduce-bottlenecks-in-the-emergency-department-Lahiri-22.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (2805Kb) | Preview |
Official URL: http://dx.doi.org/10.3390/healthcare10050942
Abstract
Increasing demand and changing case-mix have resulted in bottlenecks and longer waiting times in emergency departments (ED). However, many process improvement efforts addressing the bottlenecks have limitations, as they lack accurate models of the real system as input accounting for operational complexities. To understand the limitations, this research modelled granular procedural information, to analyse processes in a Level-1 ED of a 1200-bed teaching hospital in the UK. Semi-structured interviews with 21 clinicians and direct observations provided the necessary information. Results identified Majors as the most crowded area, hence, a systems modelling technique, role activity diagram, was used to derive highly granular process maps illustrating care in Majors which were further validated by 6 additional clinicians. Bottlenecks observed in Majors included awaiting specialist input, tests outside the ED, awaiting transportation, bed search, and inpatient handover. Process mapping revealed opportunities for using precedence information to reduce repeat tests; informed alerting; and provisioning for operational complexity into ED processes as steps to potentially alleviate bottlenecks. Another result is that this is the first study to map care processes in Majors, the area within the ED that treats complex patients whose care journeys are susceptible to variations. Findings have implications on the development of improvement approaches for managing bottlenecks.
| Item Type: | Journal Article | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RA Public aspects of medicine | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Engineering > Engineering | ||||||||
| Library of Congress Subject Headings (LCSH): | Hospitals -- Emergency services -- Risk management, Hospitals -- Waiting lists -- Simulation methods , Medical appointments and schedules -- Simulation methods | ||||||||
| Journal or Publication Title: | Healthcare | ||||||||
| Publisher: | MDPI | ||||||||
| ISSN: | 2227-9032 | ||||||||
| Official Date: | 19 May 2022 | ||||||||
| Dates: |
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| Volume: | 10 | ||||||||
| Number: | 5 | ||||||||
| Article Number: | 942 | ||||||||
| DOI: | 10.3390/healthcare10050942 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 27 June 2022 | ||||||||
| Date of first compliant Open Access: | 28 June 2022 |
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