Modeling emergency department operations using advanced computer simulation systems.

We developed a computer simulation model of emergency department operations using simulation software. This model uses multiple levels of preemptive patient priority; assigns each patient to an individual nurse and physician; incorporates all standard tests, procedures, and consultations; and allows patient service processes to proceed simultaneously, sequentially, repetitively, or a combination of these. Selected input data, including the number of physicians, nurses, and treatment beds, and the blood test turnaround time, then were varied systematically to determine their simulated effect on patient throughput time, selected queue sizes, and rates of resource utilization. Patient throughput time varied directly with laboratory service times and inversely with the number of physician or nurse servers. Resource utilization rates varied inversely with resource availability, and patient waiting time and patient throughput time varied indirectly with the level of patient acuity. The simulation can be animated on a computer monitor, showing simulated patients, specimens, and staff members moving throughout the ED. Computer simulation is a potentially useful tool that can help predict the results of changes in the ED system without actually altering it and may have implications for planning, optimizing resources, and improving the efficiency and quality of care.