_Xiang Yu_

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The Saintemarie University hospital is a large and complex healthcare with more than 2000 beds, and the
hospitals ED is the only emergency care unit available in the metropolitan area. However, the hospital has a
severe condition in Emergency Department congestion. Patients spent on average five hours in the ED after they
had been registered, excluding spending-time in the observational area, and there were a large amount patients
complaining about their waiting time and left the hospital before they could receive treatments. This caused a
great impact on hospitals medical quality, HR, economic. The hospitals administrative and CEO were aware of
this serious situation but still struggled to decide which measures should be taken to mitigate the growing wait
times.

The inflow of patients coming to the ED of Saintemarie remained relatively stable during the past few years.
Therefore, the main reason for congestion is caused by the hospitals internal inefficiency instead of the
increasing number of patients. Besides, the general problem for congestion is the whole EDs healthcare system
becoming not that much dynamic.[1]
As for the specific problems:
1. The preliminary time for patients is too long in the emergency department. Nurses and physicians need time
to sort patients and registration.
2. The inefficiency and shift the blame to others shoulders between technical staff, physicians, and nurses are
also one of the problems.
3. For more complex cases, obtaining advice from other specialist in the hospital takes a long time.
4. Medical team needs a long time to make a decision in patient care.
5. Transferring patients to the OU usually takes a long time due to the heavy administrative paperwork.

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After patients arrive, they should be triaged by nurses or physicians. But the triage physicians sometimes are
too busy or reluctant to perform this task. And after triage, the registration is still needs about 10 mins. After
sorting and registration, patients should wait a room to be available for an hour and 10 minutes on average
with a nurse to determine the priority given to each patient and manage the workload.
This preliminary time for patients is too long in the emergency department.[2]
Required laboratory tests or radiology exams for patients took hours to complete. Doctors blamed the lack of
resources and the inefficiency of the technical staff, while the technical staff blamed the nurses for being
slow for transporting patients. And there is blank-time between each patient for CT scanner.
the ED medical staff will seek advice from other specialist in the hospital, and it cost a long time for a doctor
to come down to ED and check the patients condition as they may busy with their own patients.
There are lot of administrative paper work that should be done before transfer patients to the OU, and it takes
an hour on average. So many time have been wasted during every process. Even the occupancy rate is high
in the hospital, the efficiency is one of the biggest concern in this hospital.

The EDs performance evaluation system should be re-designed.

Each part of the system should be evaluated by their performance, as we know, the reason why CT scanner

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taking such a long time to be done because the technical staff, the physician, and the nurse do not perform
well in their own position. Therefore, to redesign a new performance evaluation system is important in order
to improve the current condition.
The more advanced technical electronical system should be put into practice, to increase efficiency and to
save the paper work time as well. Treatment tasks are ordered by the physician and will have an estimated
time and can therefore be sequenced. Each time that the EDG is updated, there is an opportunity to update
task lists and task durations and to reschedule. This could make each part of the system more functional and
efficient. [3, 4]

Homer, J.B. and G.B. Hirsch, System dynamics modeling for public health: background and
opportunities.(OPPORTUNITIES AND DEMANDS IN PUBLIC HEALTH SYSTEMS)(Author
Abstract). The American Journal of Public Health, 2006. 96(3): p. 452.
Luscombe, R. and E. Kozan, Dynamic resource allocation to improve emergency department
efficiency in real time. European Journal of Operational Research, 2016. 255(2): p. 593-603.
Chan, H., et al., Lean techniques for the improvement of patients' flow in emergency
department. World journal of emergency medicine, 2014. 5(1): p. 24.
Brailsford, S.C., et al., Emergency and on-demand health care: modelling a large complex
system. Journal of the Operational Research Society, 2004. 55(1): p. 34.