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The Impact of Ambulance and Patient Diversion on Crowdedness of Multiple Emergency Departments in a Region

Emergency department (ED) overcrowding threatens healthcare quality. Ambulance diversion (AD) may relieve ED overcrowding; however, diverting patients from an overcrowded ED will load neighboring EDs with more patients and may result in regional overcrowding. The purpose of this study was to evaluat...

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Autores principales: Kao, Chung-Yao, Yang, Jhen-Ci, Lin, Chih-Hao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684360/
https://www.ncbi.nlm.nih.gov/pubmed/26659589
http://dx.doi.org/10.1371/journal.pone.0144227
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author Kao, Chung-Yao
Yang, Jhen-Ci
Lin, Chih-Hao
author_facet Kao, Chung-Yao
Yang, Jhen-Ci
Lin, Chih-Hao
author_sort Kao, Chung-Yao
collection PubMed
description Emergency department (ED) overcrowding threatens healthcare quality. Ambulance diversion (AD) may relieve ED overcrowding; however, diverting patients from an overcrowded ED will load neighboring EDs with more patients and may result in regional overcrowding. The purpose of this study was to evaluate the impact of different diversion strategies on the crowdedness of multiple EDs in a region. The importance of regional coordination was also explored. A queuing model for patient flow was utilized to develop a computer program for simulating AD among EDs in a region. Key parameters, including patient arrival rates, percentages of patients of different acuity levels, percentage of patients transported by ambulance, and total resources of EDs, were assigned based on real data. The crowdedness indices of each ED and the regional crowdedness index were assessed to evaluate the effectiveness of various AD strategies. Diverting patients equally to all other EDs in a region is better than diverting patients only to EDs with more resources. The effect of diverting all ambulance-transported patients is similar to that of diverting only low-acuity patients. To minimize regional crowdedness, ambulatory patients should be sent to proper EDs when AD is initiated. Based on a queuing model with parameters calibrated by real data, patient flows of EDs in a region were simulated by a computer program. From a regional point of view, randomly diverting ambulatory patients provides almost no benefit. With regards to minimizing the crowdedness of the whole region, the most promising strategy is to divert all patients equally to all other EDs that are not already crowded. This result implies that communication and coordination among regional hospitals are crucial to relieve overall crowdedness. A regional coordination center may prioritize AD strategies to optimize ED utility.
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spelling pubmed-46843602015-12-31 The Impact of Ambulance and Patient Diversion on Crowdedness of Multiple Emergency Departments in a Region Kao, Chung-Yao Yang, Jhen-Ci Lin, Chih-Hao PLoS One Research Article Emergency department (ED) overcrowding threatens healthcare quality. Ambulance diversion (AD) may relieve ED overcrowding; however, diverting patients from an overcrowded ED will load neighboring EDs with more patients and may result in regional overcrowding. The purpose of this study was to evaluate the impact of different diversion strategies on the crowdedness of multiple EDs in a region. The importance of regional coordination was also explored. A queuing model for patient flow was utilized to develop a computer program for simulating AD among EDs in a region. Key parameters, including patient arrival rates, percentages of patients of different acuity levels, percentage of patients transported by ambulance, and total resources of EDs, were assigned based on real data. The crowdedness indices of each ED and the regional crowdedness index were assessed to evaluate the effectiveness of various AD strategies. Diverting patients equally to all other EDs in a region is better than diverting patients only to EDs with more resources. The effect of diverting all ambulance-transported patients is similar to that of diverting only low-acuity patients. To minimize regional crowdedness, ambulatory patients should be sent to proper EDs when AD is initiated. Based on a queuing model with parameters calibrated by real data, patient flows of EDs in a region were simulated by a computer program. From a regional point of view, randomly diverting ambulatory patients provides almost no benefit. With regards to minimizing the crowdedness of the whole region, the most promising strategy is to divert all patients equally to all other EDs that are not already crowded. This result implies that communication and coordination among regional hospitals are crucial to relieve overall crowdedness. A regional coordination center may prioritize AD strategies to optimize ED utility. Public Library of Science 2015-12-11 /pmc/articles/PMC4684360/ /pubmed/26659589 http://dx.doi.org/10.1371/journal.pone.0144227 Text en © 2015 Kao et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Kao, Chung-Yao
Yang, Jhen-Ci
Lin, Chih-Hao
The Impact of Ambulance and Patient Diversion on Crowdedness of Multiple Emergency Departments in a Region
title The Impact of Ambulance and Patient Diversion on Crowdedness of Multiple Emergency Departments in a Region
title_full The Impact of Ambulance and Patient Diversion on Crowdedness of Multiple Emergency Departments in a Region
title_fullStr The Impact of Ambulance and Patient Diversion on Crowdedness of Multiple Emergency Departments in a Region
title_full_unstemmed The Impact of Ambulance and Patient Diversion on Crowdedness of Multiple Emergency Departments in a Region
title_short The Impact of Ambulance and Patient Diversion on Crowdedness of Multiple Emergency Departments in a Region
title_sort impact of ambulance and patient diversion on crowdedness of multiple emergency departments in a region
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4684360/
https://www.ncbi.nlm.nih.gov/pubmed/26659589
http://dx.doi.org/10.1371/journal.pone.0144227
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