Kang Hyojung, Nembhard Harriet Black, Rafferty Colleen, DeFlitch Christopher J
Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park, PA; Penn State Hershey Medical Center, and the Penn State University Center for Integrated Healthcare Delivery Systems, Pennsylvania State University, University Park, PA.
Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, Pennsylvania State University, University Park, PA; Penn State Hershey Medical Center, and the Penn State University Center for Integrated Healthcare Delivery Systems, Pennsylvania State University, University Park, PA.
Ann Emerg Med. 2014 Oct;64(4):335-342.e8. doi: 10.1016/j.annemergmed.2014.04.011. Epub 2014 May 27.
We investigate the effect of admission process policies on patient flow in the emergency department (ED).
We surveyed an advisory panel group to determine approaches to admission process policies and classified them as admission decision is made by the team of providers (attending physicians, residents, physician extenders) (type 1) or attending physicians (type 2) on the admitting service, team of providers (type 3), or attending physicians (type 4) in the ED. We developed discrete-event simulation models of patient flow to evaluate the potential effect of the 4 basic policy types and 2 hybrid types, referred to as triage attending physician consultation and remote collaborative consultation on key performance measures.
Compared with the current admission process policy (type 1), the alternatives were all effective in reducing the length of stay of admitted patients by 14% to 26%. In other words, patients may spend 1.4 to 2.5 hours fewer on average in the ED before being admitted to internal medicine under a new admission process policy. The improved flow of admitted patients decreased both the ED length of stay of discharged patients and the overall length of stay by up to 5% and 6.4%, respectively. These results are framed in context of teaching mission and physician experience.
An efficient admission process can reduce waiting times for both admitted and discharged ED patients. This study contributed to demonstrating the potential value of leveraging admission process policies and developing a framework for pursuing these policies.
我们调查了入院流程政策对急诊科患者流量的影响。
我们对一个咨询小组进行了调查，以确定入院流程政策的方法，并将其分类为入院决策由医疗服务团队（主治医生、住院医生、医师助理）（类型1）或主治医生（类型2）在入院服务中做出、医疗服务团队（类型3）或急诊科的主治医生（类型4）做出。我们开发了患者流量的离散事件模拟模型，以评估4种基本政策类型和2种混合类型（称为分诊主治医生咨询和远程协作咨询）对关键绩效指标的潜在影响。
与当前的入院流程政策（类型1）相比，其他方案在将入院患者的住院时间缩短14%至26%方面均有效。换句话说，在新的入院流程政策下，患者在被内科收治前在急诊科平均可能少花费1.4至2.5小时。入院患者流程的改善分别使出院患者的急诊科住院时间和总住院时间最多减少了5%和6.4%。这些结果是在教学任务和医生经验的背景下得出的。
高效的入院流程可以减少急诊科入院和出院患者的等待时间。本研究有助于证明利用入院流程政策的潜在价值，并为推行这些政策制定一个框架。
