__________________ INTRODUCTION The problem of long waiting times is common for all entities of the health care system. Much attention has been given to the problem of uninsured individuals’ use of the Emergency Department (ED) for many routine health concerns that more properly should be addressed in the physician’s office setting. In this circumstance, the primary health care provider is forced to offer the best outcomes within limited resources. Optimization of patient flow and bottleneck elimination in key departments could become a possible solution that decreases operational cost and boosts quality of care. The authors collected actual data over a one-year period for arrivals, waiting times, service times, and the severity of the patients’ conditions. These data were categorized by month, day of the week, and time of day. The data were collected for four different waiting situations within the ED system. The objective was to identify those strategies which led to shorter waits for the patients, and therefore greater throughput rates and higher efficiency for the hospital, but without sacrificing the quality of patient care or significantly increasing costs. The ED is one of the most highly congested units that faces greater pressure compared with other components of the health care system. Delays in the Emergency Department may have particularly dramatic outcomes for patients. According to a survey provided by the Kaiser Family Foundation (2008), the number of emergency room visits in Mississippi on average is 4045 percent higher than nationwide (Table 1).
Hospital ER visits per 1,000 population, 1999-2005 700 600
Number of visits per year
500 400 300 200 100 0 United States Mississippi
United States Mississippi
1999 365 516
2000 366 519
2001 372 525
2002 382 543
2003 382 554
2004 383 552
2005 387 573
Table 1. Hospital Emergency Room Visits per 1,000 Population, 1999-2005 (Adopted from Kaiser Family foundation (2007) www.statehealthfacts.org)
Several factors that contribute to the higher use of the ED have been identified. Padgett and Brodsky (1992) and Baker et al. (1994) determined that people from low socioeconomic class and racial minorities use the emergency health services as a regular source of primary care. The uninsured and the people on Medicare and Medicaid use the ED as a primary care provider much more often than those covered by private third-party payer (Nadel, 1993). Under these pressures, it is crucial for hospitals to develop methodology for improving patient flow, providing the best possible care in a timely manner, and ensuring maximum utilization of limited resources. This study employs the Flexsim simulation software to model the operations of the ED in a regional hospital and evaluate strategies that will ease the bottlenecks and reduce waiting times for patients in the ED. MODELING THE ED USING COMPUTER SIMULATION SOFTWARE From queuing...