Assessment of emergency department efficiency using data envelopment analysis

Despite the important role of emergency department (ED) performance measurement, commonly used metrics remain disaggregated and are not standardized. The objectives of this study are to develop an aggregated performance measure that enables benchmarking EDs with respect to technical and scale efficiencies, and to investigate significant exogenous factors affecting the technical efficiency of EDs. To our best knowledge, this is the first study that examines the scale and technical efficiencies of EDs and helps to address hospital redesign/reengineering. This study formulated input-oriented data envelopment analysis (DEA) models that involve three inputs and three outputs and derived efficiency scores for individual EDs. The DEA analysis indicated that many EDs may not need to modify the size of their operations to improve efficiency. Instead, they may need to focus their efforts on re-engineering their processes to use their inputs more efficiently. The logistic regression analysis demonstrated that additional functional areas within the ED, length of stay, and percent of patients who arrive by ambulance were associated with the technical efficiency of EDs. This research is significant in that hospitals can use these models as benchmarking tools, and the findings can be a basis to redesign EDs with respect to critical hospital resources for performance improvement.