Minimizing flow-time and time-to-first-treatment in an Emergency Department through simulation

Emergency Department management is a resource constrained environment that has gained attention in recent years. An in-depth literature review was conducted and two patient flow models, Virtual Streaming (VS) and Physician Directed Queuing (PDQ), were selected to be contrasted against a FIFO-baseline model using discrete event simulation. Scenarios were constructed by assigning doctors to 4-hour shifts. Model performance was ranked by finding the minimum aggregated time to first treatment (TTFT) of admitted patients and the length of stay (LOS) of discharged patients. The benefits from PDQ were seen largely by Emergency Severity Index (ESI) 4 and 5 patients and the benefits from VS were seen largely by ESI 2 and 3 patients. Results suggest VS for the patient mix used herein when the system is near capacity and the baseline when the system is not near capacity. However, trade-offs and improvements of these models are discussed.