Impact of an observation unit and an emergency department-admitted patient transfer mandate in decreasing overcrowding in a pediatric emergency department: a discrete event simulation exercise

Pediatr Emerg Care. 2009 Mar;25(3):160-3. doi: 10.1097/PEC.0b013e31819a7e20.


Objectives: The primary objective was to examine the effects of a simulated observation unit (OU) and a transfer mandate for admitted patients on pediatric emergency department (PED) patient flow indicators. The secondary objective was to report on the occupancy rate of the simulated OU.

Methods: Simulations were conducted using a previously designed and validated discrete event simulation model of our PED operations. A simulated OU was designed, and an emergency department-admitted patient transfer mandate was developed and then applied to a discrete event simulation model. Four scenarios (regular PED operations with and without a 5-bed OU and transfer mandate in all combinations) were modeled.

Results: A combination of an OU and an emergency department-admitted patient transfer mandate resulted in reductions in time to be seen by a physician and length of stay in patients who were triaged with urgent or emergent presentations as compared with PED operations with neither an OU nor a transfer mandate. Small improvements in fractile response were observed for patients triaged with urgent presentations. The OU without the transfer mandate had a simulated occupancy rate of 73.1%. The inclusion of the transfer mandate reduced the occupancy rate to 48.1%.

Conclusions: Simulation scenario analyses predict that an OU and a transfer mandate would reduce overcapacity in the PED, with more substantial reductions in time to be seen and length of stay for patients of high acuity.

Publication types

  • Comparative Study

MeSH terms

  • British Columbia
  • Child
  • Computer Simulation*
  • Hospital Units / organization & administration
  • Hospitalization / statistics & numerical data*
  • Hospitals, Pediatric / organization & administration*
  • Humans
  • Intensive Care Units, Pediatric / organization & administration*
  • Patient Admission / statistics & numerical data*
  • Patient Selection
  • Patient Transfer / organization & administration*