CLIENT:
Orange Regional Medical Center CASE STUDY
Middletown, NY
Fully understanding the problem allows us to develop solutions that focus on the root cause. Sometimes it is difficult for staff to see what is happening beyond the confines of their reality. In this case, the emergency department (ED) was very crowded with patients waiting for inpatient beds. The ED believed they needed more treatment space, but root cause analysis helped us see that the real need was for inpatient beds.
CHALLENGE
EXECUTIVE SUMMARY
The emergency department (ED) is
Initially focused on redesigning their emergency department (ED), Orange Regional
experiencing daily holds. Currently,
Medical Center (ORMC) engaged Array Advisors to map the current and future state
observation patients are sent to any
process. It became clear that there were some downstream bottlenecks causing the
available bed in the hospital. Staff fears
ED to be overwhelmed with patients.
that this bed assignment paradigm may
The ORMC team was interested in seeing if they could increase ED capacity by adding
be causing the back-up in the ED. Array
holding beds for admitted patients waiting in the ED for an inpatient bed. We used a
looks to provide clarity around the impact
simulation model to test the effect of implementing the future state patient flow.
of improving flow in the ED and cohorting
Holding beds appeared to alleviate the problem, but we did not believe they were
observation patients.
the best use of capital and they clearly did not solve the root cause of the issue.
SOLUTION
We recommended ORMC perform a study of the inpatient and observation patient
Throughput Analysis
We hypothesized that moving observation patients, who were currently being treated
interaction to determine if inpatient bed capacity was the root cause. in inpatient beds, to a cohorted unit would create capacity for admitted inpatients and
After developing a future state work
reduce the number of holds in the ED.
flow focused on separating the very sick patients from the less sick patients in the
Array’s modeler developed a second simulation model to study the utilization and
emergency department (ED), Array worked
bed need of all inpatient units. The model also demonstrated the effect of treating
to determine how a dedicated observation
observation patients in a dedicated unit, rather than inpatient units.
unit would impact current crowding in the
The models provided the ORMC team with visuals, helping them see the impact of
ED.
adding an observation unit. This also helped them determine the best use of their capital dollars.
PROJECT HIGHLIGHTS
2
Simulation Models: 1 ED, 1 inpatient
30
Observation Beds Needed to Reduce ED holding
6
RAZ Positions Added