Chih-Hao Lin1, Chung-Yao Kao2, Chong-Ye Huang3. 1. Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. 2. Department of Electrical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan. Electronic address: cykao@mail.nsysu.edu.tw. 3. Department of Electrical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan.
Abstract
BACKGROUND/ PURPOSE: Ambulance diversion (AD) is considered one of the possible solutions to relieve emergency department (ED) overcrowding. Study of the effectiveness of various AD strategies is prerequisite for policy-making. Our aim is to develop a tool that quantitatively evaluates the effectiveness of various AD strategies. METHODS: A simulation model and a computer simulation program were developed. Three sets of simulations were executed to evaluate AD initiating criteria, patient-blocking rules, and AD intervals, respectively. The crowdedness index, the patient waiting time for service, and the percentage of adverse patients were assessed to determine the effect of various AD policies. RESULTS: Simulation results suggest that, in a certain setting, the best timing for implementing AD is when the crowdedness index reaches the critical value, 1.0 - an indicator that ED is operating at its maximal capacity. The strategy to divert all patients transported by ambulance is more effective than to divert either high-acuity patients only or low-acuity patients only. Given a total allowable AD duration, implementing AD multiple times with short intervals generally has better effect than having a single AD with maximal allowable duration. CONCLUSION: An input-throughput-output simulation model is proposed for simulating ED operation. Effectiveness of several AD strategies on relieving ED overcrowding was assessed via computer simulations based on this model. By appropriate parameter settings, the model can represent medical resource providers of different scales. It is also feasible to expand the simulations to evaluate the effect of AD strategies on a community basis. The results may offer insights for making effective AD policies.
BACKGROUND/ PURPOSE: Ambulance diversion (AD) is considered one of the possible solutions to relieve emergency department (ED) overcrowding. Study of the effectiveness of various AD strategies is prerequisite for policy-making. Our aim is to develop a tool that quantitatively evaluates the effectiveness of various AD strategies. METHODS: A simulation model and a computer simulation program were developed. Three sets of simulations were executed to evaluate AD initiating criteria, patient-blocking rules, and AD intervals, respectively. The crowdedness index, the patient waiting time for service, and the percentage of adverse patients were assessed to determine the effect of various AD policies. RESULTS: Simulation results suggest that, in a certain setting, the best timing for implementing AD is when the crowdedness index reaches the critical value, 1.0 - an indicator that ED is operating at its maximal capacity. The strategy to divert all patients transported by ambulance is more effective than to divert either high-acuity patients only or low-acuity patients only. Given a total allowable AD duration, implementing AD multiple times with short intervals generally has better effect than having a single AD with maximal allowable duration. CONCLUSION: An input-throughput-output simulation model is proposed for simulating ED operation. Effectiveness of several AD strategies on relieving ED overcrowding was assessed via computer simulations based on this model. By appropriate parameter settings, the model can represent medical resource providers of different scales. It is also feasible to expand the simulations to evaluate the effect of AD strategies on a community basis. The results may offer insights for making effective AD policies.
Authors: Lauren F Laker; Elham Torabi; Daniel J France; Craig M Froehle; Eric J Goldlust; Nathan R Hoot; Parastu Kasaie; Michael S Lyons; Laura H Barg-Walkow; Michael J Ward; Robert L Wears Journal: Acad Emerg Med Date: 2017-09-21 Impact factor: 3.451
Authors: Seyed Mohammad Esmaeil Fazl Hashemi; Ali Sarabi Asiabar; Aziz Rezapour; Saber Azami-Aghdash; Hassan Hosseini Amnab; Seyed Abbas Mirabedini Journal: Med J Islam Repub Iran Date: 2017-12-14
Authors: Pei-Yu Wang; Pin-Hui Fang; Chen-Long Wu; Hsiang-Chin Hsu; Chih-Hao Lin Journal: Int J Environ Res Public Health Date: 2019-10-16 Impact factor: 3.390