Grant: Travel Awards - Institute Community Support

Prolonged waiting times in emergency departments (EDs) have been an international issue mainly caused by increased ED visits and care needs. The amount of time Canadians spend in EDs increased 12% compared to 3 years ago with a median ED length-of-stay 10.8 hours for admitted patients in 2018. Excessive ED waiting times are the result of a resource being a bottleneck (or constraint) in the clinical pathway of patients. In order to provide a solution on how to alleviate resource constraints and to improve effectiveness and efficiency in ED care delivery, there needs to be a better understanding of patient's urgency and complexity to guide their care pathway. The term urgency has received the major attention in emergency medicine due to its clinical significance. Meanwhile, complexity, which represents resource requirements for completing care for a patient in the ED, is an immature concept that could bring significant operational implications. The notion of complexity is receiving a growing attention recently with ever increasing concerns on operational efficiency (as a key factor affecting care quality) in EDs, without proper definition and measure. In this study, we characterize patient complexity levels by proposing a measurement method tested on data from four different EDs and report operational insights. We design a model to characterize and classify complexity levels of patients that consider the impacts of operational factors (i.e., the use of various resources) on ED crowding and waiting times. This can be done by testing indirect effects by building mediation models. We show how patient features (e.g., complaints and vital signs) guided operational factors (e.g., computed tomography scan utilization) and how operational factors in turn influenced operational performances (e.g., waiting time). We evaluate the reliability and validity of the approach for estimating patient complexity in the four different EDs and discuss possible use of the knowledge.