Modelling based framework for the management of emergency departments.

In the twenty-first century, the healthcare industry faces ever-changing economic, social, political and technology challenges. Costs are rising, funding is diminishing, human and fiscal resources are becoming scarcer, customer-expectations are rising, the complexity of disease is increasing and technology is becoming more complex. These trends have a massive impact on every aspect of hospital operations and the Emergency Department is no exception. Overcrowding in the Emergency Department (ED) in hospitals has become a growing problem in many developed countries around the world. ED overcrowding has a direct effect on patient-care, including compromised patient-safety, increased length-of-stay, increased mortality and morbidity-rates and increased costs. Healthcare policy-makers and hospital and ED administrators are being forced to search for ways to improve the capacity of EDs by better utilisation of existing resources and creating more efficient systems to overcome this problem.Throughout the past few decades, there has been an increasing trend of using numerous systems-analysis tools and techniques which have come from manufacturing and other service industries to address the various issues in healthcare and EDs. Among those tools Discrete-Event Simulation (DES) is a powerful tool to improve the efficiency and capacity in dynamic and complex systems. Use of these tools to address the overcrowding problem in EDs has been patchy; specific aspects of issues have been studied but no attempt has been made to deploy DES or any other systems-analysis tool in a strategic and holistic manner.The aim of this research is to develop a modelling-based framework to manage the overcrowding problem in EDs. The research identified the causes of overcrowding in EDs and developed a decisions-framework with the long-term, medium-term and short-tem decisions in EDs that related to the overcrowding problem. Finally, it identified the best possible systems-analysis tools to support those decisions to overcome the overcrowding problem in EDs. This research could help the healthcare policy-makers, managers, systems-engineers as well as the researchers and consultants who are interesting in the Emergency Department operational management.