Designing an Expert System for Management of Crowding and Overcrowding in Emergency Departments

Document Type : Research Paper

Authors

1 Department of Information Technology, Tarbiat Modares University, Tehran, I.R. Iran

2 Department of Industrial Engineering, Tarbiat Modares University, Tehran, I.R. Iran

Abstract

  Providing service for patients in a rapid and efficient manner is one of the main issues in concern to Emergency Department (ED). Due to the imbalance between needs and the capacity of providing service, ED faces an emergency situation. In this paper, through the use of information gathered from related literature, an Expert System (ES) has been designed in order to detect ED crowding and overcrowding and provide appropriate solutions in order to return to a normal situation. In relation to this matter, National Emergency Department Overcrowding Scale (NEDOCS) has been used as an indicator. According to the value of NEDOCS the status of ED can be categorized in five groups consisting of normal, crowded, overcrowded, dangerous and disastrous classes. Furthermore, based on the situation of ED and in accordance to the related literature, proper solutions are provided by the proposed ES in order to overcome the adverse status. Developed ES consisting of 30 rules provides the mentioned solutions based on interactions with users, referral to knowledge base and necessary inferences via user interface. Results of applying the proposed ES indicate 81 percent compatibility between solutions provided by the ES and those proposed by ED’s experts.

Keywords

References

1. Kyriacou, D. N., Ricketts, V., Dyne, P. L., McCollough, M. D., and Talan, D. A. (1999). “A 5-Year Time Study Analysis of Emergency Department Patient Care Efficiency.” ANN EMERG MED, Vol. 34, No. 3.
2. Ejeli, M. and Safari, H. (2011). “Performance Evaluation of Decision Making Units Using Performance Prediction Neural Network Hybrid and DEA: A Case Study-National Iranian Gas Company.” (2011) (In Persian), Journal of Industrial Engineering, Vol. 45, No.1, 13-29.
3. Memar Jafari, M., Gatmiri, Z., and Khakzar Bafrouni, M. (2011). “CMS Analysis using Discrete Simulation: A Case Study.” (In Persian), Journal of Industrial Engineering, Vol. 45, No.1, 95-102.
4. Bradley, V. M. (2005). “Placing Emergency Department Crowding on the Decision Agenda.” J EMERG NURS, Vol. 31, No. 3, 247-258.
5. American College of Emergency Physicians (2008). “Emergency Department Crowding- Information Paper.” USA: ACEP, Available at www.acep.org [Accessed 18 April 2012].
6. Moskop, J. C., Sklar, D. P., Geiderman, J. M., Schears, R. M., and Bookman, K. J. (2009). “Emergency Department Crowding, Part 1—Concept, Causes, and Moral Consequences.” ANN EMERG MED, Vol. 53, No. 5, 605-611.
7. Fatovich, D. M. and Hirsch, R. L. (2003). “Entry overload, emergency department overcrowding, and ambulance bypass.” J EMERG MED, Vol. 20, No. 1, 406–409.
8. Emergency Nurses Association (2006). “Emergency Nurses Association Position Statement: Crowding in the Emergency Department.” J EMERG NURS, Vol. 32, No. 1, 42-47.
9. Hoot, N. R. and Aronsky, D. (2008). “Systematic Review of Emergency Department Crowding: Causes, Effects, and Solutions.” ANN EMERG MED, Vol. 52, No. 2, 126- 136.
10. McCarthy, M. L., Aronsky, D., Jones, I. D. Miner, J. R., Band, R. A., Baren, J. M., ... & Shesser, R. (2008) “The emergency department occupancy rate: a simple measure of emergency department crowding.” ANN EMERG MED, 15-24.
11. Bernstein, S. L., Boggs, R., Derlet, R., Handly, N., Hinfey, P., and Kamens, D. (2006). “AAEM Policy Paper- Emergency Department Crowding: Past, Present and Future Directions.” AAEM: Milwaukee.
12. Velianoff, G. D. (2002). “Overcrowding and Diversion in the Emergency Department- The Health Care Safety Net Unravels.” J EMERG NURS, Vol. 37, No. 1, 9- 66.
13. Trzeciak, S. and Rivers, E. P. (2003). “Emergency Department overcrowding in the United States: An emerging threat to patient safety and public health.” J EMERG MED, Vol. 20, No. 5, 402-405.
14. Schull, M., Lazier, K., Vermeulen, M., Mawhinney, S., and Morrison, L. J. (2003). “Emergency department contributors to ambulance diversion: A quantitative analysis.” ANN EMERG MED, Vol. 41, No. 4, 467-476.
15. Schafermeyer, R. W. and Asplin, B. R. (2003). “Hospital and emergency department crowding in the United States.” J EMERG MED, Vol. 15, 22–27.
16. Kelen, G. D., Scheulen, J. J., and Hill, P. M. (2001). “Effect of an emergency department (ED) managed acute care unit on ED overcrowding and emergency medical services diversion.” ACAD EMERG MED, Vol. 8, No. 11, 1095-1100.
17. GAO (United States General Accounting Office) (2003). “Hospital Emergency Departments- Crowded Conditions Vary among Hospitals and Communities.” [GAO-03-460] USA: Ranking Minority Member, Committee on Finance, U.S. Senate.
18. Dunham, C. M. (2001). “Emergency Department Overcrowding in Massachusetts. Making Room in our Hospitals.” Massachusetts: The Massachusetts Health Policy Forum.
19. Derlet, R. W. and Richards, J. R. (2000). “Overcrowding in the Nation’s Emergency Departments: Complex Causes and Disturbing Effects.” ANN EMERG MED, Vol. 35, No. 1, 63-68.
20. US Department of Commerce, Economics and statistics Administration (2009). “Statistical Abstact of the United States: The National Data Book.” United States: Census Bureau. Available at: http://books.google.com [accessed April 2012].
21. Schweigler, L. M., Desmond, J. S., McCarthy, M. L., Bukowski, K. J., Ionides, E. L., and Younger, J. G. (2009). “Clinical Practice- Forecasting Models of Emergency Department Crowding.” Illinois: Society for Academic Emergency Medicine, Available at: < http://www.saem.org/ > [Accesses at December 2011].
22. Schneider, S. M. (2009). “Emergency Department Crowding.” EMERG MED, Vol. 30, No. 3, 13-23.
23. Harwood, G. (2005). “Emergency Department Overcrowding.”. British Colombia: Fraser Health Authority.
24. Cooke, M., Fisher, J., Dale, J., McLeod, E., Szczepura, A., Walley, P., and Wilson, S. (2005). “Reducing Attendances and Waits in Emergency Departments: A systematic review of present innovations.” [pdf] London: National Co-ordinating Centre for NHS Service Delivery and Organization R & D (NCCSDO).
25. Collis, J. (2010). “Adverse effects of overcrowding on patient experience and care.” EMERG NURSE 2010; Vol. 18, No. 8, 34-39.
26. Olshaker, J. S. and Rathley, N. S. (2006). “Emergency Department overcrowding and ambulance diversion: The impact and potential solutions of extended boarding of admitted patients in the Emergency Department.” J EMERG MED, Vol. 30, No. 3, 351-356.
27. Razmi, J. and Yousofi, M. (2012). “A New Mathematical Model and Related Algorithm for School Bus Routing Problem.” (In Persian) Journal of Industrial Engineering, Vol. 46, No. 2, 185-194.
28. Kolb, E. M. W., Peck, J., Schoening, S., and Lee, T. (2008). “Reducing Emergency Department Overcrowding- Five Patient Buffer Concepts in Comparison.” Proceedings of the 2008 Winter Simulation Conference. Florida, 7- 10 December, USA: IEEE.
29. Nolan, J. (2011). “Emergency Department Boarding Practices in the United States.” Ph. D. University of California, San Francisco.
30. Welch, S. and Savitz, L. (2011). “Exploring Strategies to Improve Emergency Department Intake.” J EMERG MED, 26 May, 1-10.
31. Liao, S. H. (2005). “Expert system methodologies and applications- a decade review from 1995 to 2004.” Expert Systems with Applications, 93-103.
32. Fasanghari, M. and Montazer, G. A. (2010). “Design and implementation of fuzzy expert system for Tehran Stock Exchange portfolio recommendation.” Expert Systems with Applications, 6138–6147.
33. Rezaei, K., Sadegh Amal Nik, M., and Nazari Shirkoohi, S. (2009). “Automatic Self Assessment System Design Based on ISO 9004:2000 applying Expert System Approach.” (In Persian) Journal of Industrial Engineering, Vol. 43, No. 1, 51-57.
34. Hoot, N. R., LeBlanc, L. J., Jones, I., Levin, S. R., Zhou, C., Gadd, C. S., and Aronsky, D. (2007). “Measuring and Forecasting Emergency Department Crowding in Real Time.” ANN EMERG MED, Vol. 49, No. 6, 747- 755.
35. GAO (United States General Accounting Office) (2009). “Hospital Emergency Departments- Crowding Continues to Occur, and Some Patients Wait Longer than Recommended Time Frames.” [GAO-09-347] USA: Ranking Minority Member, Committee on Finance, U.S.
36. Barr, R. S., Golden, B. L., Kelly, J., Stewart, W. R., and Resende, M. G. C. (2001). “Guidelines for Designing and Reporting on Computational Experiments with Heuristic Methods.” Dallas: Southern Methodist University.
37. Elahi, SH., Khadivfar, A., and Hasanzadeh, A. (2011). “Designing a Decision Making Expert System for Knowledge Management Strategy Process.” (In Persian) Information Technology Management, Vol. 3, No. 8, 43-62.
Advances in Industrial Engineering
Volume 48, Issue 2 - Serial Number 2
October 2014
Pages 281-292

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