Improving Quality of Care in a Multidisciplinary Emergency Department by the Use of simulation Optimization - Preliminary Results.

A major challenge of an emergency department (ED) is managing the growing patient volume without diminishing quality of care nor increasing costs. Therefore, this case study aims at minimizing the average patient's length-of-stay (LOS) subject to a given staffing budget. It is based on data of a multidisciplinary ED in Germany with an annual volume of 50,000 patients. We analyze the impact of process modifications, staff pooling, and optimized staffing levels on the LOS. In order to optimize staffing levels, we combine optimization models with discrete-event simulation. The simulation model is built on treatment processes of different medical specialties that were mapped by time-motion studies. Results show that avoiding boarding time and pooling of nurses originally assigned to internal medicine or neurology are particularly promising. These lead to improvements of 15% and 14% in avg. LOS, respectively. Optimizing staff allocation results in reductions of up to 9% in avg. LOS.