Simulation Modeling and Analysis
Simulation Modeling and Analysis
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The objective of this study was to investigate the effect of inpatient boarding on the degree of Emergency Department (ED) overcrowding. We developed a discrete-event simulation (DES) approach to model ED patient flow based on a census of 26,984 patients from January through May, 2008. We modeled the Emergency Department of the University of California, Davis, Medical Center (UCDMC). This hospital is a Level 1 academic trauma center with an annual ED census of approximately 60,000. We used the National Emergency Department Over-Crowding Scale (NEDOCS) as our primary performance metric. Our decision variable was the boarder-released-ratio, which we defined as the ratio of admitted patients whose boarding time is zero to all admitted patients. Our analysis shows that under the current boarder-released-ratio conditions at UCDMC, 88.4% of days were defined as "Overcrowded+" (a NEDOCS score of over 100). When the boarder-released-ratio was increased from 0% to 50%, Overcrowded+ days decreased from 88.4% to 68.0%. Likewise, when the boarder-released-ratio was 100% (no patients held in the ED awaiting inpatient beds), the Overcrowded+ ratio fell to 50.4%. These results show that inpatient boarding significantly impacts the NEDOCS score. This analysis provides a quantification of the impact of boarding on emergency department patient crowding.