Needy boarding patients in emergency departments: An exploratory case study using discrete-event simulation

Abstract

Boarding patients and the extra workload they introduce are a major concern in emergency departments. Currently, research on boarding has focused on the beds that these patients occupy while they wait for admission in the inpatient ward. Little attention has been given to the check-ups these patients will inevitably need while waiting. These check-ups also confront the physicians with a challenging task: prioritizing between boarding patients and patients currently under treatment in the emergency department. This article firstly explores the limited previous research on boarding patients. Secondly, this paper quantitatively demonstrates that needy boarding patients can significantly impact system performance and hence should be accounted for in the analysis and planning of an emergency department through discrete-event simulation. Next, three static priority policies (first-come, first-served and always prioritizing either boarding patients or the other patients) and one dynamic priority policy (using accumulating priorities) are evaluated on various performance measures. We find, for our case study, that system performance is optimized by applying a priority policy that favours patients currently under treatment in the emergency department.