Simulating Emergency Department Boarding Using a Difference Equation
AbstractBackgroundThis paper aims to provide a model that can be used to simulate the effect of patient presentation counts on ED boarder counts and investigate strategies that might be used for managing ED boarding levels.MethodsA boarding simulation model is constructed using a random variable and two regressions that are linked together in a difference equation. The simulation is run under varying constraints, including time interval, presentation counts, and boarder count threshold. Bootstrapping is used to run the simulation a large number of times so that mean and medians can be calculated along with confidence intervals.ResultsThe method outlined in this paper can be used to simulate the effect of presentation levels on ED boarder counts. Using these methods one can derive quantifiable estimates of time that an emergency department might meet or exceed a particular boarder count threshold.ConclusionsThese simulation methods can help an emergency department understand the dynamics of the system in the status quo of normal operations and quantify the relationship of presentation counts and throughput to the hospital. We are hopeful that others may use these methods, adapting, developing, and testing for their own institutions.