Defining an optimal ED fast track strategy using simulation

Purpose – The Emergency Department (ED) at Grand River Hospital in Kitchener, Ontario sought insight into strategies that would reduce patient length of stay and queuing for initial assessment. The purpose of this paper is to focus on the ED's operational level and determine an optimal fast track strategy to improve performance measures. Design/methodology/approach – The paper describes the application of discrete event simulation to the ED's “fast track” system and determines an optimal fast track strategy to improve performance measures. Topics discussed include: the design and development process for the simulation model, proposed operational strategies, and the analysis of scenarios for optimizing fast track. Findings – Length of stay and queue length were most significantly reduced when there was an increased physician presence in the fast track system, followed by an additional emergency nurse practitioner in the system. Finally, the implementation of See‐and‐treat had a negligible effect on both performance measures for fast‐tracked patients. Originality/value – Using real data, the effectiveness of a number of fast track strategies within a hospital ED were evaluated, which have practical implications for reducing patient wait times in ERs. This would be most valuable to practitioners in areas such as health service research, simulation modeling, and health service delivery.