title: Managing emergency department overcrowding via ambulance diversion: a discrete event simulation model.
abstract: OBJECTIVE
  Ambulance diversion (AD) is considered one of the possible solutions to relieve emergency department (ED) overcrowding. Study of the effectiveness of various AD strategies is prerequisite for policy-making. Our aim is to develop a tool that quantitatively evaluates the effectiveness of various AD strategies.
  
  
  METHODS
  A simulation model and a computer simulation program were developed. Three sets of simulations were executed to evaluate AD initiating criteria, patient-blocking rules, and AD intervals, respectively. The crowdedness index, the patient waiting time for service, and the percentage of adverse patients were assessed to determine the effect of various AD policies.
  
  
  RESULTS
  Simulation results suggest that, in a certain setting, the best timing for implementing AD is when the crowdedness index reaches the critical value, 1.0 - an indicator that ED is operating at its maximal capacity. The strategy to divert all patients transported by ambulance is more effective than to divert either high-acuity patients only or low-acuity patients only. Given a total allowable AD duration, implementing AD multiple times with short intervals generally has better effect than having a single AD with maximal allowable duration.
  
  
  CONCLUSIONS
  An input-throughput-output simulation model is proposed for simulating ED operation. Effectiveness of several AD strategies on relieving ED overcrowding was assessed via computer simulations based on this model. By appropriate parameter settings, the model can represent medical resource providers of different scales. It is also feasible to expand the simulations to evaluate the effect of AD strategies on a community basis. The results may offer insights for making effective AD policies.
authors.affiliation: Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors.forename: Chih-Hao
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Electrical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan. Electronic address: cykao@mail.nsysu.edu.tw.
authors.forename: Chung-Yao
authors.initials: CY
authors.lastname: Kao
authors.affiliation: Department of Electrical Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan.
authors.forename: Chong-Ye
authors.initials: CY
authors.lastname: Huang
mesh_terms: D064422:Ambulance Diversion; D000552:Ambulances / Q000706:statistics & numerical data*; D003198:Computer Simulation; D003441:Crowding; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D013997:Time Factors
keywords: ambulance diversion; emergency department overcrowding; simulation