Quantifying patient flow and utilization with patient flow pathway and diagnosis of an emergency department in Singapore
- 75 Downloads
Patient treatment and care in emergency departments (ED) is complex because of differences in patients’ acuity, co-morbidities and diagnoses. This paper aims to study how different diagnosis groups impact the utilization, which we estimate from patients’ touch points, of various functional areas at ED. We first mapped patient flow pathways across key functional areas in ED, and illustrated them using a network graph. We measured the utilization of these key areas and stratified them by diagnosis groups. The contribution of each diagnosis group to the area utilization was then estimated. A mathematical model was developed to perform impact analysis on the demand based on the utilization pattern. In particular, we estimated the changes in patients’ touch points in the key areas with the changes to the volumes of different diagnosis groups. The study showed that different diagnosis groups have different impact on the demand at the functional areas. In particular, patients with the diagnosis ‘Symptoms, signs and ill-defined conditions’ had the highest impact on the demand in almost all ED areas. The diagnosis ‘Acute respiratory infections’ appeared to have higher impact on the demand in the areas of Fever and Fever Observation.
Keywordsemergency department utilization diagnosis patient flow pathway impact analysis
The authors are grateful to the anonymous referees for their careful readings and suggestions, which helped to improve the presentation of the paper. We would also like to thank Kenneth Lim Teck Kiat from Health Services & Outcomes Research, National Healthcare Group Singapore for assisting with the manuscript revision.
- CDC (2011) ICD-9-CM official guidelines for coding and reporting [WWW document] http://www.cdc.gov/nchs/data/icd9cm_guidelines_2011.pdf (accessed 15 January 2015).
- Delia D (2007) Hospital Capacity, Patient Flow, and Emergency Department Use in New Jersey. Rutgers Center for State Health Policy, New Brunswick, New Jersey, US.Google Scholar
- GAO (Government Accountability Office) (2009) Hospital emergency departments: crowding continues to occur, and some patients wait longer than recommended time frames [WWW document] http://www.gao.gov/new.items/d09347.pdf (accessed 15 January 2015).
- Nicks BA and Manthey DM (2012) The impact of psychiatric patient boarding in emergency departments. Emergency Medicine International 2012 (2012), 360308.Google Scholar
- Richardson L, Asplin B and Lowe R (2002) Emergency department crowding as a health policy issue: past development, future directions. Academic Emergency Medicine 40 (4), 388–393.Google Scholar
- Richardson DB and Mountain D (2009) Myths versus facts in emergency department overcrowding and hospital access block. Medical Journal of Australia 190 (7), 369–374.Google Scholar
- Wasserman S and Faust K (2008) Social Network Analysis: Methods and Applications. Cambridge University Press, Cambridge, UK.Google Scholar