Abstract for: Emergency Department Crowding: Vicious Cycles in the ED

Over the past several decades, demands on the United States emergency and trauma care system have grown dramatically, but the capacity of the system has not kept pace. The result is a widespread phenomenon of crowded emergency rooms, especially in urban hospitals, which has become a major barrier to receiving timely care and has been implicated in adverse medical outcomes. This paper develops a stylized system dynamics model to examine the dynamics of patient flow in emergency departments. Simulation results show that increased ED resilience can come from relaxing bed constraints or from more human capability to cope with increasing workloads. The vulnerability of this system is rooted in the critical interaction between physical constraints imposed by the environment and the human capability of the staff to work at high performance levels under conditions of worsening workload pressure.