Abstract for: Put Em in the Hallway: Adaptive Processes in the Emergency Department

Patient arrivals at emergency departments (EDs) have been increasing even while ED capacity has been stagnant or falling. To adjust to overloads, EDs often put patients in hallway beds resulting in sub-optimal care. Drawing on reports from emergency physicians and department chairs, we develop a stylized system dynamics model of patient flow through an ED and use it to explore the dynamics of several tactics to accommodate increasing demand. The model replicates the observed reference mode of capacity expansion by the continued incremental addition of hallway beds leading to more and more patients outside the physical limits of the ED. Simulations demonstrate the fragility of ED and hospital systems that are operating at close to full capacity utilization. Effective solutions likely require adjustments in the ED and in the hospital more broadly.