Abstract

Background: Hospitals need to provide timely access to emergency department services in an effective and efficient way. Computer simulation has become a widely accepted tool for evaluating different operational schemes to support managerial decision making processes. We report a simulation study to analyze the impact of different emergency physician shift structures on two emergency department (ED) performance indicators. Objectives: i) To improve emergency physician utilization rates, measured as the total time spent by the emergency physician attending patients divided by the duration of the shift, and ii) To improve average patient turnaround times, measured as the time elapsed between the instant the patient arrives to the ED and the instant the patient leaves the ED. Methods: We constructed a discrete event simulation model that generates patients that follow different paths throughout the ED. The model could simulate the emergency department behavior when changing the emergency physicians' schedules and the number of physicians attending patients simultaneously. We evaluated 6 different scenarios including the current operation. Results: By changing the emergency physician shift structure and the number of emergency physicians attending patients simultaneously, the model showed a 49.5% reduction on patient turnaround times, and a 71.8% increase in physician utilization rates. At the same time, the ED requirement of emergency physician hours per day decreased by 38.1%. Conclusions: Computer simulation showed that it is possible to decrease the number of emergency physician hours per day and, at the same time, decrease patient turnaround times.