A Quantitative Analysis of Integrated Emergency Posts

As a solution to overcrowding, emergency departments (ED) in the Netherlands start to collaborate with general practitioner cooperatives (GPC) in so-called integrated emergency posts (IEP) to make sure that self-referring patients receive the right treatment by the right care provider. The underlying assumption is that this collaboration will increase effectiveness of care and efficiency. This chapter describes two case studies: for one case study the IEP has already been opened upon the start of this research, whereas for the other case study the decision to open an IEP was not made yet. Furthermore, the two case studies differ in several ED and GPC characteristics, like the percentage of self-referring patients. For both case studies, we compare the situation before integration, the so-called non-integrated post (NIP), with the IEP. The analysis is done using a discrete-event simulation model, which is set up in a generic way to enable analysing different NIPs and IEPs without drastically changing the model. We illustrate the latter using the two case studies. We furthermore show that integration without considering capacitive or organizational changes might lead to an increase in length of stay (LOS) for patients at the GPC as well as at the ED. However, when the capacities and responsibilities are changed accordingly, the introduction of an IEP has a positive impact towards patients and leads to less overcrowding at the ED. These results led to the decision to also open the IEP in the second case study.