Experimental Design and Simulation Applied to a Paediatric Emergency Department: A Case Study

This study assesses the effectiveness of a novel organisational solutioncalledanticipated treatmentas a means ofreducing crowding in paediatric emergency departments(PEDs) by shortening patient wait time and length of stay.This is the first published account of such an intervention in a PED, in whichtriage nurses can prescribe diagnostic tests for non-urgent respiratory or trauma patients before firstassessmentby a physician. The effectiveness of the proposed solution was assessed by simulating areal case at a leading Italian children’s hospital. Coupled with increasedtriage nurse staffingin winter months,implementation of anticipated treatment was found to reduceaveragepre-triage wait time, timeto initial physician assessmentand length of stayby 7.7%, 5% and 8.7%, respectively.More significantly, anticipated treatmentshortenedlength of stayamongrespiratoryand trauma patientsby up to 44.6% and 14.5%, respectively. The study also compares therelative effectiveness of anticipated treatment andthesee and treatprotocol and discusses how these solutions can interact.