- Hamed Hassanzadeh, Justin Boyle, Vahid Riahi, Hwan-Jin Yoon, Ibrahima Diouf, Sankalp Khanna, Clair Sullivan, Andrew Staib, Emma Bosley, Mahnaz Samadbeik, James F. Lind
Correspondence: hamed.hassanzadeh@csiro.au
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Abstract
Objective
To assess the impact of strategies to improve public hospital emergency access using a detailed ward-level simulation modelling approach.
Design and Setting
Discrete event simulation was used to simulate patient flow at three principal referral Australian hospitals from 1 September 2021 to 31 August 2022. Models were developed and validated using every emergency department (ED) presentation, inpatient episode of care and patient ward movement at the study hospitals.
Main Outcome Measures
Mean and total ED length of stay, mean waiting time, access block rate, 4-h rule compliance and bed utilisation for patients admitted from the ED.
Results
Reducing ED demand via arrangements that accommodate the same proportion and types of admissions from the ED as the existing ED presenting population reduces access block, with larger impacts in winter than in summer. However, reducing ‘general practitioner-type patients’ in EDs has negligible impact on access block. Tangible impacts on improving patient flow can be achieved by removing maintenance care patients from hospitals (reducing the percentage of access block by up to a third) and reducing elective admissions. Strategies that emphasised morning, midday and early afternoon discharges led to large flow improvements. The strategy already practised by most hospitals of sharing patients among wards greatly improves emergency access, and gains are the same order of magnitude as reducing overall ED demand.
Conclusions
The study provides support to policymakers looking for evidence regarding strategies to improve emergency access to public hospital care.