Modelling patient flow in an emergency department to better understand demand management strategies

This paper presents a simulation model of the emergency department (ED) at a major UK hospital, which like most other EDs, is struggling to meet the key ED performance target to admit or discharge 95% of patients within 4 h of arrival. Only marginal improvements have been evidenced from recent investigations piloted as attempts to improve cost, quality and throughput in the ED, leading to increased enthusiasm from management to explore the potential of simulation to expedite patient flow. The objective of this project was to create a discrete event simulation model of the ED to improve understanding of the current system, identify shortcomings of previously piloted interventions and assess the impact of alternative initiatives. The project has served as an excellent means to promote simulation as an effective tool to design ED services. Its success to generate outputs above those anticipated by management has accelerated the development of a multidisciplinary Flow Team, which meets regularly at the hospital to review improvements and explore further proposals to improve patient flow.