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Delivering Responsive Care in the Emergency Department: Targeting the Population Versus a Disease-Specific Approach

Ward, Michael J
http://orcid.org/0000-0002-4561-2946
http://rave.ohiolink.edu/etdc/view?acc_num=ucin14798177488784

Abstract Details

2016, PhD, University of Cincinnati, Business: Business Administration.
The value delivered by the U.S. healthcare system to American patients continues to diminish and lags behind other developed nations. Nowhere is this challenge more evident than in access to healthcare services for acute, unscheduled visits as seen in the emergency department (ED) where waiting times to see a clinical provider average nearly an hour. Existing disease-based approaches to process improvement prioritize the performance of the ED for a very limited number of patients with specific conditions. Due to the preference for the use of clinical outcomes (e.g., mortality) rather than operational outcomes (e.g., length of stay), overall system performance may be compromised in order to meet the needs of a limited subset of diseases (e.g., stroke or acute myocardial infarction). Alternatively, population-based approaches take a more comprehensive approach by viewing the healthcare system as a series of interconnected parts rather than individual silos. The research in the following three essays addresses both population-level and disease-based process improvement. In the first two essays, we examine the use of a population-level approach that uses a dynamic capacity allocation policy we call “Relook.” Relook assigns resources (nurses) to patients depending upon need throughout the ED visit. Using discrete event simulation, we examined how waiting time (arrival-to-bed placement interval) performance in an example ED using a Relook policy compares to astatic policy. We found that a Relook policy reduces waiting times, costs, and is reasonably robust to the time between patient reevaluation. These benefits were achieved through re-allocating capacity to lower-intensity resources (i.e., nurses who can care for more patients simultaneously) periodically throughout the patient’s ED visit. In the third essay, we examine a targeted approach to treating patients who present to the ED with a condition called heart failure. Heart failure is a common condition for which patients present to the ED and are frequently hospitalized. For patients with lower heart failure severity, if there were delays to the administration of a medication that removes excess fluid from their bodies (i.e., diuretic), patients were more likely to remain in the hospital. As a central source of care for patients, targeting the ED and the downstream consequences of activities that occur in the ED could be a potential source of cost savings in healthcare. These three essays provide an examination of ED performance from two different perspectives: a population-level and a diseased-based approach. Taken together, these three essays provide a promising direction for process improvement in healthcare, particularly the ED. Solely targeting individual conditions may not only not address the operational changes needed for that disease, but may also neglect other conditions both known and unknown to be time-sensitive. Such a dual approach is needed to enhance the responsiveness of the emergency care system.
Craig Froehle, Ph.D. (Committee Chair)
Gary D. Scudder, Ph.D. (Committee Member)
Mark Eckman, M.D. (Committee Member)
W. David Kelton, Ph.D. (Committee Member)
Michael Magazine, Ph.D. (Committee Member)
138 p.
Operations Research
Emergency Department; Discrete Event Simulation; Operations; Capacity Allocation; Wait Time; Heart Failure

Recommended Citations

Citations

  • Ward, M. J. (2016). Delivering Responsive Care in the Emergency Department: Targeting the Population Versus a Disease-Specific Approach [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin14798177488784

    APA Style (7th edition)

  • Ward, Michael. Delivering Responsive Care in the Emergency Department: Targeting the Population Versus a Disease-Specific Approach. 2016. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin14798177488784.

    MLA Style (8th edition)

  • Ward, Michael. "Delivering Responsive Care in the Emergency Department: Targeting the Population Versus a Disease-Specific Approach." Doctoral dissertation, University of Cincinnati, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ucin14798177488784

    Chicago Manual of Style (17th edition)

ucin14798177488784
416
© 2016, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.