A dynamic model of the systemic causes for patient treatment delays in emergency departments

PurposeThe purpose of this paper is to report on the development of a qualitative systems model developed to understand why average emergency department (ED) length of stay (LOS) was rapidly increasing while the number of ED visits was relatively constant. The paper's focus was to identify systemic causes for poor patient flow so that the model could then be used to evaluate improvement options using a more complete view of the causal structure for the ED delays. Design/methodology/approachIn this case study, a disciplined system dynamics approach was used that included development of a dynamic hypothesis, causal loop and stock and flow diagramming, interviews with system experts, and data collection and analysis. FindingsResults support the dynamic hypothesis that an aging population and shortages of resources to treat chronically ill patients (among other dynamics) were causing longer average LOS. Older and sicker patients were consuming more ED resources and causing less acute patients to leave without being seen or to avoid visiting the ED in the first place. In essence, the ED was acting as a safety valve for the wider health care system as many parts of this wider system became overloaded. Practical implicationsOwing to the systemic causes for the patient treatment delay problem in the ED, simple local solutions are unlikely to be effective. The system model can be used as a basis to understand the underlying dynamics of the systemic causes for poor patient flow and identify robust and long-term solutions. Originality/valueThe paper presents a process for developing a dynamic model to engage the various participants in a health care system in understanding the causes for delays and poor patient flow. The modeling approach can be used as a means for health care managers/administrators to identify improvement options that address the systemic problems.