Evaluating the effects of increasing surgical volume on emergency department patient access

BMJ Qual Saf. 2011 Feb;20(2):146-52. doi: 10.1136/bmjqs.2008.030007. Epub 2011 Jan 5.


Aim: To determine how increases in surgical patient volume will affect emergency department (ED) access to inpatient cardiac services. To compare how strategies to increase cardiology inpatient throughput can either accommodate increases in surgical volume or improve ED patient access.

Methods: A stochastic discrete event simulation was created to model patient flow through a cardiology inpatient system within a US, urban, academic hospital. The simulation used survival analysis to examine the relationship between anticipated increases in surgical volume and ED patient boarding time (ie, time interval from cardiology admission request to inpatient bed placement).

Results: ED patients boarded for a telemetry and cardiovascular intensive care unit (CVICU) bed had a mean boarding time of 5.3 (median 3.1, interquartile range 1.5-6.9) h and 2.7 (median 1.7, interquartile range 0.8-3.0) h, respectively. Each 10% incremental increase in surgical volume resulted in a 37 and 33 min increase in mean boarding time to the telemetry unit and CVICU, respectively. Strategies to increase cardiology inpatient throughput by increasing capacity and decreasing length of stay for specific inpatients was compared. Increasing cardiology capacity by one telemetry and CVICU bed or decreasing length of stay by 1 h resulted in a 7-9 min decrease in average boarding time or an 11-19% increase in surgical patient volume accommodation.

Conclusions: Simulating competition dynamics for hospital admissions provides prospective planning (ie, decision making) information and demonstrates how interventions to increase inpatient throughput will have a much greater effect on higher priority surgical admissions compared with ED admissions.

MeSH terms

  • Academic Medical Centers
  • Cardiology Service, Hospital / statistics & numerical data
  • Cohort Studies
  • Emergency Service, Hospital*
  • Health Services Accessibility*
  • Humans
  • Models, Theoretical
  • Patient Transfer
  • Proportional Hazards Models
  • Retrospective Studies
  • Stochastic Processes
  • Surgical Procedures, Operative / statistics & numerical data*
  • Survival Analysis
  • United States