Mohiuddin Syed, Busby John, Savović Jelena, Richards Alison, Northstone Kate, Hollingworth William, Donovan Jenny L, Vasilakis Christos
NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
School of Social and Community Medicine, University of Bristol, Bristol, UK.
BMJ Open. 2017 May 9;7(5):e015007. doi: 10.1136/bmjopen-2016-015007.
Overcrowding in the emergency department (ED) is common in the UK as in other countries worldwide. Computer simulation is one approach used for understanding the causes of ED overcrowding and assessing the likely impact of changes to the delivery of emergency care. However, little is known about the usefulness of computer simulation for analysis of ED patient flow. We undertook a systematic review to investigate the different computer simulation methods and their contribution for analysis of patient flow within EDs in the UK.
We searched eight bibliographic databases (MEDLINE, EMBASE, COCHRANE, WEB OF SCIENCE, CINAHL, INSPEC, MATHSCINET and ACM DIGITAL LIBRARY) from date of inception until 31 March 2016. Studies were included if they used a computer simulation method to capture patient progression within the ED of an established UK National Health Service hospital. Studies were summarised in terms of simulation method, key assumptions, input and output data, conclusions drawn and implementation of results.
Twenty-one studies met the inclusion criteria. Of these, 19 used discrete event simulation and 2 used system dynamics models. The purpose of many of these studies (n=16; 76%) centred on service redesign. Seven studies (33%) provided no details about the ED being investigated. Most studies (n=18; 86%) used specific hospital models of ED patient flow. Overall, the reporting of underlying modelling assumptions was poor. Nineteen studies (90%) considered patient waiting or throughput times as the key outcome measure. Twelve studies (57%) reported some involvement of stakeholders in the simulation study. However, only three studies (14%) reported on the implementation of changes supported by the simulation.
We found that computer simulation can provide a means to pretest changes to ED care delivery before implementation in a safe and efficient manner. However, the evidence base is small and poorly developed. There are some methodological, data, stakeholder, implementation and reporting issues, which must be addressed by future studies.
与世界其他国家一样，急诊科过度拥挤在英国很常见。计算机模拟是用于理解急诊科过度拥挤原因以及评估紧急护理服务变更可能产生影响的一种方法。然而，对于计算机模拟在急诊科患者流分析中的有用性知之甚少。我们进行了一项系统综述，以调查不同的计算机模拟方法及其对英国急诊科患者流分析的贡献。
我们检索了8个文献数据库（MEDLINE、EMBASE、COCHRANE、科学网、护理学与健康领域数据库、INSPEC、数学评论和美国计算机协会数字图书馆），检索时间从各数据库建库起至2016年3月31日。如果研究使用计算机模拟方法来描述英国一家既定的国民保健服务医院急诊科内患者的进展情况，则纳入该研究。研究从模拟方法、关键假设、输入和输出数据、得出的结论以及结果的实施等方面进行总结。
21项研究符合纳入标准。其中，19项使用离散事件模拟，2项使用系统动力学模型。这些研究中许多（n = 16；76%）的目的集中在服务重新设计上。7项研究（33%）未提供所调查急诊科的详细信息。大多数研究（n = 18；86%）使用了急诊科患者流的特定医院模型。总体而言，基础建模假设的报告情况较差。19项研究（90%）将患者等待时间或周转时间视为关键结果指标。12项研究（57%）报告称利益相关者参与了模拟研究。然而，只有3项研究（14%）报告了模拟支持的变更的实施情况。
我们发现计算机模拟可以提供一种手段，以便在安全、高效地实施之前对急诊科护理服务的变更进行预测试。然而，证据基础较小且发展不完善。存在一些方法学、数据、利益相关者、实施和报告方面的问题，未来的研究必须加以解决。
