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Anqi Liu-MS Thesis.pdf (1.29 MB)

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Modeling of the Patient Flow Process in the Pediatric Emergency Department and Identification of Relevant Factors

Liu, Anqi
http://rave.ohiolink.edu/etdc/view?acc_num=osu1524050557071021

Abstract Details

2018, Master of Science, Ohio State University, Public Health.
Average emergency department (ED) wait times have gradually increased during the past decade, and identifying relevant factors to reduce ED wait times is of crucial importance. The main purpose of this thesis was to model the process by which patients enter the ED, are seen by physicians, and discharged from the Emergency Department at Nationwide Children’s Hospital, as well as identify modifiable factors that are associated with ED lengths of stay. In this study, 68,210 patients admitted to the ED from March 1st, 2016 to February 28th, 2017 were analyzed using a multi-state model of the ED process. Cox proportional hazards models with transition-specific covariates were used to model each transition in the multi-state model and the Aalen-Johansen estimator was used to obtain transition probabilities and state occupation probabilities in the ED process. This was contrasted with a Kaplan-Meier curve and Cox proportional hazard model of the overall ED length of stay. Only patients who transitioned sequentially through each state in the model were included in the analysis. In the overall ED length of stay, there are significant differences in discharge rates according to age, gender, ethnicity and race. Patients with higher acuity level, who were seen in the summer months, and who arrived in the ED between 8 am and 12 pm left the ED more quickly. A significant association was also found between the number of ED physicians and discharge rate. In the multi-state model, the demographic covariates did not show obvious, clinically relevant differences for each of the transitions. Important differences were seen between acuity levels, seasons, time of the day and the number of ED physicians in the four transitions. In conclusion, the multistate model presented in this Thesis decomposes the overall ED length of stay into constituent transitions and allow investigators to model covariate-specific effects on each transition. This allows physicians to understand the ED process and identify which potentially modifiable covariates would have the greatest impact on reducing the waiting times in each state in the model.
Guy Brock (Advisor)
Michael Pennell (Committee Member)
David Kline (Committee Member)
66 p.
Medicine; Public Health
ED wait times; multi-state model

Recommended Citations

Citations

  • Liu, A. (2018). Modeling of the Patient Flow Process in the Pediatric Emergency Department and Identification of Relevant Factors [Master's thesis, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1524050557071021

    APA Style (7th edition)

  • Liu, Anqi. Modeling of the Patient Flow Process in the Pediatric Emergency Department and Identification of Relevant Factors. 2018. Ohio State University, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1524050557071021.

    MLA Style (8th edition)

  • Liu, Anqi. "Modeling of the Patient Flow Process in the Pediatric Emergency Department and Identification of Relevant Factors." Master's thesis, Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1524050557071021

    Chicago Manual of Style (17th edition)

osu1524050557071021
376
© 2018, all rights reserved.
This open access ETD is published by The Ohio State University and OhioLINK.