title: What Can Emergency Medicine Learn From Kinetics: Introducing an Alternative Evaluation and a Universal Criterion Standard for Emergency Department Performance.
abstract: This research focuses on developing an improved and robust measurement for emergency department (ED) performance and a criterion standard for global use via kinetic analysis. Based on kinetic approach, the input-throughput-output conceptual model of ED crowding is compared to the procedure of enzyme catalysis. All in average, the retented patients in EDs are defined as substrate (S), whereas the patients who depart the EDs as product (P). Therefore, the average ED departure velocity (V) can be presented as (P)divided by a given time (t) of the ED length of stay (LOS). The S-V and S²-P plots are depicted hourly for the kinetic analysis. The long-term stability of the kinetic parameters is ascertained by the method of coefficient of variation (CV). The participants collected for this study are from the EDs of Changhua Christian Medical Center and the five branched hospitals, all located in Taiwan. Based on the S-V plot analysis, the results clearly show 2 curves, an upper and a lower curve. The timeline of the lower curve includes approximately the total ED busy hours, and thus it can be used for the subsequent kinetic analysis. In order to explore the adequate kinetic parameters for ED performance, the try-and-error process was followed in this study. As a result, the S²-V plots adapted from the lower curves show the best linear regression of S² on V with a good coefficient of determination (R). The Pan-Wen constant (PW), which is the slope of the liner regression line, and the ED medical personnel unit turnover number (EDMPU TON) were deduced from the kinetic meanings of (Equation is included in full-text article.)plots. In this research, the 2 kinetic parameters, PW and EDMPU TON were applied for the ED performance evaluations. An innovative relationship between the ED retented patients and the ED departure velocity is verified as PW; whereas, a feasible kinetic parameter, the EDMPU TON explicates the teamwork efficiency of the ED providers. Moreover, the EDMPU TON may not only be a reliable universal criterion standard for the ED performance, but also a valuable reference for both ED providers and payers.
authors.affiliation: From the Graduate School of Engineering Science and Technology (C-LP), National Yunlin University of Science & Technology, Douliou, Taiwan, China; Department of Emergency Medicine (C-FC, C-WC), Changhua Christian Medical Center, Changhua, Taiwan, China; Department of Emergency Medicine (C-HC), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, China; Key Laboratory of Hydraulics and Mountain River Engineering (ZT), Sichuan University, Chengdu, China; Department of Electrical Engineering (J-HW), Tunghai University, Taichung, Taiwan, China; and Department and Graduate School of Safety and Environment Engineering (J-CW), Research Center for Soil & Water Resources and Natural Disaster Prevention, National Yunlin University of Science & Technology, Douliou, Taiwan, China.
authors.forename: Chih-Long
authors.initials: CL
authors.lastname: Pan
authors.forename: Chin-Fu
authors.initials: CF
authors.lastname: Chang
authors.forename: Chun-Wen
authors.initials: CW
authors.lastname: Chiu
authors.forename: Chih-Hsien
authors.initials: CH
authors.lastname: Chi
authors.forename: Zhong
authors.initials: Z
authors.lastname: Tian
authors.forename: Jyh-Horng
authors.initials: JH
authors.lastname: Wen
authors.forename: Jet-Chau
authors.initials: JC
authors.lastname: Wen
mesh_terms: D003441:Crowding; D017598:Efficiency, Organizational / Q000592:standards*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D007700:Kinetics; D007902:Length of Stay; D017146:Models, Organizational; D010343:Patient Admission / Q000592:standards*; D058996:Quality Improvement; D013624:Taiwan