@article{ref1,
title="Modeling emergency department crowding: restoring the balance between demand for and supply of emergency medicine",
journal="PLoS one",
year="2021",
author="Ong, Marcus Eng Hock and Shen, Yuzeng and Lee, Lin Hui and Ahmad, Salman and Schoenenberger, Lukas and Matchar, David Bruce and Ansah, John Pastor",
volume="16",
number="1",
pages="e0244097-e0244097",
abstract="Emergency Departments (EDs) worldwide are confronted with rising patient volumes causing significant strains on both Emergency Medicine and entire healthcare  systems. Consequently, many EDs are in a situation where the number of patients in  the ED is temporarily beyond the capacity for which the ED is designed and resourced  to manage-a phenomenon called Emergency Department (ED) crowding. ED crowding can  impair the quality of care delivered to patients and lead to longer patient waiting  times for ED doctor's consult (time to provider) and admission to the hospital ward. In Singapore, total ED attendance at public hospitals has grown significantly, that  is, roughly 5.57% per year between 2005 and 2016 and, therefore, emergency  physicians have to cope with patient volumes above the safe workload. The purpose of  this study is to create a virtual ED that closely maps the processes of a  hospital-based ED in Singapore using system dynamics, that is, a computer simulation  method, in order to visualize, simulate, and improve patient flows within the ED. Based on the simulation model (virtual ED), we analyze four policies: (i)  co-location of primary care services within the ED, (ii) increase in the capacity of  doctors, (iii) a more efficient patient transfer to inpatient hospital wards, and  (iv) a combination of policies (i) to (iii). Among the tested policies, the  co-location of primary care services has the largest impact on patients' average  length of stay (ALOS) in the ED. This implies that decanting non-emergency lower  acuity patients from the ED to an adjacent primary care clinic significantly  relieves the burden on ED operations. Generally, in Singapore, there is a tendency  to strengthen primary care and to educate patients to see their general  practitioners first in case of non-life threatening, acute illness.<p /> <p>Language: en</p>",
language="en",
issn="1932-6203",
doi="10.1371/journal.pone.0244097",
url="http://dx.doi.org/10.1371/journal.pone.0244097"
}