Abstract
Background
Emergency department (ED) crowding correlates with patient safety. Difficulties quantifying
crowding and providing solutions were highlighted in the recent Institute of Medicine
(IOM) report calling for the application of advanced industrial engineering (IE) research
techniques to evaluate ED crowding. ED personnel workload is a related concept, with
potential reciprocal effects between the two. Collaboration between emergency medicine
and IE is needed to address crowding and ED personnel workload.
Objective
We review ED crowding and workload literature, relationships between workload and
ED crowding, and the potential application of information theory as implemented in
IE frameworks entitled “entropy” in evaluating both topics.
Discussion
IE techniques have applications for emergency medicine and have been successful in
helping improve ED operations. Lean and Six Sigma applications are some of these techniques.
Existing ED workload measures don't account for all aspects of work in the ED (acuity,
efficiency, tasks, etc.) Crowding scales, such as NEDOCS (National ED Overcrowding
Study) and EDWIN (ED Work Index), fail to predict ED crowding. A new measurement “entropy”
may provide a more comprehensive evaluation of ED workload and may predict work overload
seen with crowding. Entropy measures task-based work and the information flow involved.
By assigning an entropy value to patient type-specific tasks, we might predict when
the ED is overwhelmed, and crowded.
Conclusions
IE techniques provide solutions to the ED crowding problem and improve ED workload.
We propose a technique novel to medicine: “Entropy,” derived from information theory,
which may provide insight into ED personnel workload, its potential for measuring
ED crowding, and possibly, in predicting an overwhelming situation.
Keywords
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Article info
Publication history
Published online: January 10, 2014
Accepted:
August 20,
2013
Received in revised form:
August 2,
2013
Received:
February 23,
2013
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
