Improving the design and operation of an integrated emergency post via simulation

Abstract

In the Netherlands, patients with an acute care demand after office hours often wrongly choose to visit the emergency department (ED), while they could have visited the general practitioners' post (GPP). This may lead to overcrowding and increased costs. In this paper, we focus on an Integrated Emergency Post (IEP) at a Dutch hospital, where the ED and the GPP have been merged into a single point of access for patients. To find the optimal process design for this new IEP, we use computer simulation incorporating patient preferences. We define many potential interventions, and compare these by categorizing and grouping them, and sequentially withdrawing ineffective interventions, while accounting for possible interaction effects. Results show a sustainable solution for all stakeholders involved, reducing patients' length of stay up to 17%. Based on these results, an intervention has been trialled in practice, showing a decrease in patient LOS.