Analysis of Saturation in the Emergency Department: A Data-Driven Queuing Model Using Machine Learning.

Emergency department is a key component of the health system where the management of crowding situations is crucial to the well-being of patients. This study proposes a new machine learning methodology and a queuing network model to measure and optimize crowding through a congestion indicator, which indicates a real-time level saturation.

Multimorbidity clustering of the emergency department patient flow: Impact analysis of new unscheduled care clinics.

BACKGROUND: In France, the number of emergency department (ED) admissions doubled between 1996 and 2016. To cope with the resulting crowding situation, redirecting patients to new healthcare services was considered a viable solution which would spread demand more evenly across available healthcare delivery points and render care more efficient. The objective of this study was to analyze the impact of opening new on-demand care services based on variations in patient flow at a large hospital emergency department. METHODS: We performed a before-and-after study investigating the use of unscheduled care services in the Aube region in eastern France, that focused on ED attendance at Troyes Hospital. A hierarchical clustering based on co-occurrence of diagnoses was applied which divided the population into different multimorbidity profiles. Temporal trends of the resultant clusters were also studied empirically and using regression models. A multivariate logistic regression model was constructed to adjust the periodic effect for appropriate confounders and therefore confirm its presence. RESULTS: In total, 120,722 visits to the ED were recorded over a 24-month period (2018-2019) and 16 clusters were identified, accounting for 94.76% of all visits. There was a decrease of 56.77 visits per week in seven specific clusters and an increase of use of unscheduled health care services by 328.12 visits per week. CONCLUSIONS: Using an innovative and reliable methodology to evaluate changes in patient flow through the ED, these findings may help inform public health policy experts on the implementation of unscheduled care services to ease pressure on hospital EDs.

Effect of the COVID-19 pandemic lockdown on non-COVID-19 emergency department visits in Eastern France: Reduced risk or avoidance behavior?

OBJECTIVE: To study the impact of COVID-19 pandemic lockdown on avoided emergency department visits and consequent hospitalizations. STUDY DESIGN: An observational retrospective design was used to investigate avoided visits and hospitalizations of an departmental emergency department combined with a clustering approach on multimorbidity patterns. METHODS: A multimorbidity clustering technique was applied on the emergency department diagnostics to segment the population in diseases clusters. Global visits and hospitalizations from an emergency department during the 2020 lockdown were put in perspective with the same period during 2019. Using a comparison with the five previous years, avoided hospitalizations per inhabitants during the lockdown were estimated for each diseases cluster. RESULTS: During the 8 weeks of lockdown, the number of emergency department visits have been reduced by 41.47% and resultant hospitalizations by 28.50% compared to 2019. The retrospective study showed that 14 of 17 diseases clusters had a statistically significant reduction in hospitalizations with a pronounced effect on lower acuity diagnoses and middle-aged patient, leading to 293 avoided hospitalizations per 100,000 inhabitants compared to the 5 previous years and to the 85.8 COVID-19 hospitalizations per 100,000 inhabitants. CONCLUSION: Although specific to a regional context of pandemic containment, the study suggest that COVID-19 lockdown had beneficial effects on the crowding situation of the emergency departments and hospitals with avoidance effects primarily link to reduced risks.

An Efficient Simulation-Based Optimization Approach for Improving Emergency Department Performance.

In recent years, health care organizations, in particular emergency department (ED), have come under increasing pressure to provide quality care. In this context, human resources are a central aspect: a good utilization of health worker could improve quality of care. In this paper, a simulation model is proposed. The model represents an ED coupled with an optimization method to optimize the allocation of medical and para-medical human resources in the hospital center of Troyes. We aim to improve the quality of services offered to patients through the minimization of Average Waiting Time (AWT) and Average Inpatient Stay (AS). The proposed approach has proved to be effective to reduce AWT and AS by 12 minutes and 21 minutes respectively.

Forecasting the Emergency Department Patients Flow.

Emergency department (ED) have become the patient's main point of entrance in modern hospitals causing it frequent overcrowding, thus hospital managers are increasingly paying attention to the ED in order to provide better quality service for patients. One of the key elements for a good management strategy is demand forecasting. In this case, forecasting patients flow, which will help decision makers to optimize human (doctors, nurses…) and material(beds, boxs…) resources allocation. The main interest of this research is forecasting daily attendance at an emergency department. The study was conducted on the Emergency Department of Troyes city hospital center, France, in which we propose a new practical ED patients classification that consolidate the CCMU and GEMSA categories into one category and innovative time-series based models to forecast long and short term daily attendance. The models we developed for this case study shows very good performances (up to 91,24 % for the annual Total flow forecast) and robustness to epidemic periods.