A discrete event simulation to evaluate impact of radiology process changes on emergency department computed tomography access.

ABSTRACT

BACKGROUND: Hospitals face the challenge of managing demand for limited computed tomography (CT) resources from multiple patient types while ensuring timely access. METHODS: A discrete event simulation model was created to evaluate CT access time for emergency department (ED) patients at a large academic medical center with six unique CT machines that serve unscheduled emergency, semi-scheduled inpatient, and scheduled outpatient demand. Three operational interventions were tested adding additional patient transporters, using an alternative creatinine lab, and adding a registered nurse dedicated to monitoring CT patients in the ED. RESULTS: All interventions improved access times. Adding one or two transporters improved ED access times by up to 9.8 minutes (Mann-Whitney (MW) CI [-11.0,-8.7]) and 10.3 minutes (MW CI [-11.5, -9.2]). The alternative creatinine and RN interventions provided 3-minute (MW CI [-4.0, -2.0]) and 8.5-minute (MW CI [-9.7, -8.3]) improvements. CONCLUSIONS: Adding one transporter provided the greatest combination of reduced delay and ability to implement. The projected simulation improvements have been realized in practice.