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Evaluating the effects of increasing surgical volume on emergency department patient access
  1. S Levin1,2,
  2. R Dittus3,
  3. D Aronsky3,
  4. M Weinger3,
  5. D France3
  1. 1Operations Integration Department, Johns Hopkins Hospital, Baltimore, Maryland, USA
  2. 2Operations Integration Department, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  3. 3Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Dr Scott Levin, Department of Emergency Medicine, Johns Hopkins University, 5801 Smith Avenue, Suite 3220, Baltimore, MD 21230, USA; slevin33{at}


Aim To determine how increases in surgical patient volume will affect emergency department (ED) access to inpatient cardiac services. To compare how strategies to increase cardiology inpatient throughput can either accommodate increases in surgical volume or improve ED patient access.

Methods A stochastic discrete event simulation was created to model patient flow through a cardiology inpatient system within a US, urban, academic hospital. The simulation used survival analysis to examine the relationship between anticipated increases in surgical volume and ED patient boarding time (ie, time interval from cardiology admission request to inpatient bed placement).

Results ED patients boarded for a telemetry and cardiovascular intensive care unit (CVICU) bed had a mean boarding time of 5.3 (median 3.1, interquartile range 1.5–6.9) h and 2.7 (median 1.7, interquartile range 0.8–3.0) h, respectively. Each 10% incremental increase in surgical volume resulted in a 37 and 33 min increase in mean boarding time to the telemetry unit and CVICU, respectively. Strategies to increase cardiology inpatient throughput by increasing capacity and decreasing length of stay for specific inpatients was compared. Increasing cardiology capacity by one telemetry and CVICU bed or decreasing length of stay by 1 h resulted in a 7–9 min decrease in average boarding time or an 11–19% increase in surgical patient volume accommodation.

Conclusions Simulating competition dynamics for hospital admissions provides prospective planning (ie, decision making) information and demonstrates how interventions to increase inpatient throughput will have a much greater effect on higher priority surgical admissions compared with ED admissions.

  • Emergency department boarding
  • surgical volume
  • simulation
  • patient flow
  • emergency department
  • decision analysis

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Vanderbilt University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.