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Pediatr Emerg Care. 2009 Mar;25(3):160-3. doi: 10.1097/PEC.0b013e31819a7e20.

Impact of an observation unit and an emergency department-admitted patient transfer mandate in decreasing overcrowding in a pediatric emergency department: a discrete event simulation exercise.

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Division of Emergency Medicine, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada.



The primary objective was to examine the effects of a simulated observation unit (OU) and a transfer mandate for admitted patients on pediatric emergency department (PED) patient flow indicators. The secondary objective was to report on the occupancy rate of the simulated OU.


Simulations were conducted using a previously designed and validated discrete event simulation model of our PED operations. A simulated OU was designed, and an emergency department-admitted patient transfer mandate was developed and then applied to a discrete event simulation model. Four scenarios (regular PED operations with and without a 5-bed OU and transfer mandate in all combinations) were modeled.


A combination of an OU and an emergency department-admitted patient transfer mandate resulted in reductions in time to be seen by a physician and length of stay in patients who were triaged with urgent or emergent presentations as compared with PED operations with neither an OU nor a transfer mandate. Small improvements in fractile response were observed for patients triaged with urgent presentations. The OU without the transfer mandate had a simulated occupancy rate of 73.1%. The inclusion of the transfer mandate reduced the occupancy rate to 48.1%.


Simulation scenario analyses predict that an OU and a transfer mandate would reduce overcapacity in the PED, with more substantial reductions in time to be seen and length of stay for patients of high acuity.

[Indexed for MEDLINE]

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