Planning Capacity for Mental Health and Addiction Services in the Emergency Department: A Discrete-Event Simulation Approach

Ontario has shown an increasing number of emergency department (ED) visits, particularly for mental health and addiction (MHA) complaints. Given the current opioid crises Canada is facing and the legalization of recreational cannabis in October 2018, the number of MHA visits to the ED is expected to grow even further. In face of these events, we examine capacity planning alternatives for the ED of an academic hospital in Toronto. We first quantify the volume of ED visits the hospital has received in recent years (from 2012 to 2016) and use forecasting techniques to predict future ED demand for the hospital. We then employ a discrete-event simulation model to analyze the impacts of the following scenarios: (a) increasing overall demand to the ED, (b) increasing or decreasing number of ED visits due to substance abuse, and (c) adjusting resource capacity to address the forecasted demand. Key performance indicators used in this analysis are the overall ED length of stay (LOS) and the total number of patients treated in the Psychiatric Emergency Services Unit (PESU) as a percentage of the total number of MHA visits. Our results showed that if resource capacity is not adjusted, ED LOS will deteriorate considerably given the expected growth in demand; programs that aim to reduce the number of alcohol and/or opioid visits can greatly aid in reducing ED wait times; the legalization of recreational use of cannabis will have minimal impact, and increasing the number of PESU beds can provide great aid in reducing ED pressure.