A Simulation Analysis of an Emergency Department Fast Track System
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The basis for this thesis involved a four month Accelerate Canada internship at the Grand River Hospital Emergency Department in Kitchener, Ontario. The Emergency Department (ED) Process Committee sought insight into strategies that could potentially reduce patient length of stay in the ED, thereby reducing wait times for emergency patients. This thesis uses discrete event simulation to model the overall system and to analyze the effect of various operational strategies within the fast track area of the emergency department. It discusses the design and development process for the simulation model, proposes various operational strategies to reduce patient wait times, and analyzes the different scenarios for an optimal fast track strategy. The main contribution of this thesis is the use of simulation to determine an optimal fast track strategy that reduces patient length of stay, thereby reducing patient wait times. Wait times were most significantly reduced when there was an increased physician presence/availability towards the fast track system. This had the greatest impact on the total time spent in the ED and also on queue length. The second most significant reduction to the performance measures occurred when an additional emergency nurse practitioner was supplemented to the fast track system. Accordingly, the nurse practitioner’s percent utilization increased. There was only one two-way interaction effect that was statistically significant in reducing the primary performance measure of wait times; however, the effect did not change the queue length, a secondary performance measure, by a significant amount. Finally, the implementation of a See-and-treat model variant for fast track had a negligible effect on both the average length of stay and queue length.