The input-process-output model is quite diffuse for the analysis of health production processes. This model identifies the three main components of ED crowding: input, throughput/process and output. developed one of the most cited conceptual models of ED crowding. ED overcrowding has a relevant impact on several aspects of the overall quality of the care provided by hospitals, such as: the ability to provide critical services to patients suffering from actual medical emergencies in a timely manner the working climate since overcrowding creates frustration among ED staff (both nurses and medical doctors) patient safety and satisfaction the treatment of patients in inappropriate infrastructure settings and patients’ clinical outcomes, including higher mortality rates, errors, adverse events and increased morbidity.īy applying operations management principles to unscheduled emergency patient flow, Asplin et al. This situation occurs in hospital EDs when there are more patients than staffed ED treatment beds and wait times exceed a reasonable period” (p.174). In this paper, we adopt the interpretation of the American College of Emergency Physicians, which defines overcrowding as “a situation in which the identified need for emergency services outstrips available resources in the ED. The literature provides different possible definitions and interpretations of this concept. In the last decade, EDs worldwide have faced the challenges of cost containment, excessive waiting times, and overcrowding. Įven the case-based evidence drawn from the recent pandemic shows that the ED has been crucial in the management of COVID-19 patients : well-prepared and well-functioning EDs have achieved better results in terms of the timelines, responsiveness, and capability of separating patient flows. In this context, the emergency department (ED) plays a relevant role as, together with the outpatient departments, is one of the two entry points to the hospital production system. A better management of the flows of patients and materials throughout different healthcare production units is critical in dealing with the current challenges of healthcare systems and improving the overall quality of the care provided. In recent years, both practitioners and academics have recognized the strategic role of operations management in healthcare delivery organizations. Second, this study adopts a hospitalwide approach, adding to our understanding of ED overcrowding, which has thus far focused mainly on single aspects of ED operations. First, this study combines different research methodologies with the aim of capturing relevant information that by relying on just one research method, may otherwise be missed. The present paper represents an original contribution regarding two different aspects. With a dashboard of indicators developed following the input-process-output model, the analysis identifies the most significant variables that have an impact on ED overcrowding: the type (age and complexity) and volume of patients (input), the actual ED structural capacity (in terms of both people and technology) and the ED physician-to-nurse ratio (process), and the hospital discharging process (output). MethodsĪ mixed-method approach is used, blending qualitative inquiry with quantitative investigation in order to: i) identifying and operationalizing the main components of the model that can be addressed by hospital operation management teams and ii) testing and measuring how these components can influence ED LOS. This study aims to identify the most relevant variables that cause ED overcrowding using the input-process-output model with the aim of providing managers and policy makers with useful hints for how to effectively redesign ED operations. Literature shows that ED overcrowding impacts the overall quality of the entire hospital production system, as confirmed by the recent COVID-19 pandemic. Overcrowding occurs when the identified need for emergency services outweighs the available resources in the emergency department (ED).
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