February 17, 2018

Was Your New ED Designed to Fit the Way You Work?


Maybe you have a new emergency department (ED) under construction, or work in a newly built ED. But what if it wasn’t designed in conjunction with your specific operational processes? Either way, you will be challenged to work within the confines of the new space and meet the increased expectations that accompany it. Just because it’s shiny and new and bigger doesn’t mean it will function better or improve throughput.

Why current approaches fall short

Without sufficient collaboration from staff, planners may overlook operational issues that inform the design.

Take for example the many EDs built with no waiting areas at reception or within the department. Even in a highly efficient ED, there must be some amount of waiting. It accommodates patients who move around or family when a patient needs privacy in a treatment room. The result? Family and patients spill out into any available unofficial waiting area, such as hallways. This obstructs the efficient movement of materials and caregivers.

Other examples include doorways too small to accommodate “big boy” wheelchairs or stretchers. Or, elevators too small to accommodate stretchers. Or too much specialization amongst treatment areas, or limited staff work zones.

Why computer simulation modeling is an appropriate solution

Maybe it’s too late to influence the number of beds or the way triage works. But it’s never too late to pin down the staffing coverage or patient flow that work best in the space. Computer simulation modeling is a method that helps you figure out the best ways work with what you have. It rapidly analyzes millions of scenarios in “virtual reality” to show how different changes produce different results.

Computer Simulation Model: A good simulation model uses your department’s specific processes, patient volume, throughput data, and physical design. Staffing, scheduling, acuity, capacity and efficiency are all melded into one model to facilitate decision-making.

Case Study

One of our clients built an entirely new ED to accommodate 45,000 annual patients. They realized shortly after the fact that they should understand its performance in light of a potential increase in psychiatric and non-urgent patients. And, the department was built one floor above ground. How would handicapped or distressed patients enter? How much flexibility could they expect in their new ED? Using computer simulation we were able to create entry and staffing scenarios. We helped them understand potential utilization of different areas of the department, and suggested alternate uses of certain spaces to match their emerging needs.

Benefits of computer simulation modeling

Computer simulation modeling benefits EDs by quantifying the exact staffing and operational adjustments needed to optimize the environment. It quantifies the amount of staff needed by type and by hour of the day relative to various operational models. This approach can save thousands of annual operational dollars.

Modeling allows for a comparison of the benefits (increased capacity, decreased patient length of stay) with the costs (facility impact, staffing modifications, impacts on other departments) for each of the potential options. This leads to consensus on the options that have the best chance for success.

Key barriers and how to overcome them

You may have heard about simulation modeling before: that it takes too long, is too complicated, and too expensive. Yet, compare the cost of one simulation model to the cost of a poor patient outcome caused by insufficient or inflexible staffing. Or the cost over time of unnecessarily lengthened patient waits. Seen from this perspective, computer simulation modeling is a relative bargain.

“In the ED study, we watched our current process come alive in a way I didn’t know was possible. We needed to see it to know how ridiculous our current processes and policies are, and to begin to know what to fix. Haskell's technical skills in simulation and process mapping were excellent. This was overall an excellent engagement for us.” -Laurie Salerno, ED Business & Financial Coordinator, Froedtert Hospital & Medical Center

While it is tempting to think that solid administrative experience can stand in for a computer simulation, it can be risky business. Decisions made on the basis of intuition or historical references can backfire. Or, the Goldilocks approach means you work first through “too hot” operational approaches and then work through “too cold” before you get it “just right.” This takes time and wastes money, neither of which are in abundance. Guessing also increases risk by making your staff and patients the guinea pigs of your experiments.

By using simulation modeling to tailor your processes to your specific needs, you can experience the peace of mind that comes from knowing that the solution will work successfully.

Haskell delivers $2± billion annually in Architecture, Engineering, Construction (AEC) and Consulting solutions to assure certainty of outcome for complex capital projects worldwide. Haskell is a global, fully integrated, single-source design-build and EPC firm with over 2,200 highly specialized, in-house design, construction and administrative professionals across industrial and commercial markets. With 20+ office locations around the globe, Haskell is a trusted partner for global and emerging clients.

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