Healthc Inform Res.  2022 Jan;28(1):25-34. 10.4258/hir.2022.28.1.25.

Impact of Universal Suicide Risk Screening in a Pediatric Emergency Department: A Discrete Event Simulation Approach

• McKinley KW
• Rickard KNZ
• Latif F
• Wavra T
• Berg J
• Morrison S
• Chamberlain JM
• Patel SJ

• KMID: 2526491
• DOI: http://doi.org/10.4258/hir.2022.28.1.25

Abstract

Objectives
The aim of this study was to use discrete event simulation (DES) to model the impact of two universal suicide risk screening scenarios (emergency department [ED] and hospital-wide) on mean length of stay (LOS), wait times, and overflow of our secure patient care unit for patients being evaluated for a behavioral health complaint (BHC) in the ED of a large, academic children’s hospital.
Methods
We developed a conceptual model of BHC patient flow through the ED, incorporating anticipated system changes with both universal suicide risk screening scenarios. Retrospective site-specific patient tracking data from 2017 were used to generate model parameters and validate model output metrics with a random 50/50 split for derivation and validation data.
Results
The model predicted small increases (less than 1 hour) in LOS and wait times for our BHC patients in both universal screening scenarios. However, the days per year in which the ED experienced secure unit overflow increased (existing system: 52.9 days; 95% CI, 51.5–54.3 days; ED: 94.4 days; 95% CI, 92.6–96.2 days; and hospital-wide: 276.9 days; 95% CI, 274.8–279.0 days).
Conclusions
The DES model predicted that implementation of either universal suicide risk screening scenario would not severely impact LOS or wait times for BHC patients in our ED. However, universal screening would greatly stress our existing ED capacity to care for BHC patients in secure, dedicated patient areas by creating more overflow.

Keyword

Suicide; Mental Health; Emergency Department; Computer Simulation; Length of Stay

Figure

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  Figure 1 Conceptual model for pediatric emergency department (ED) evaluations of patients with behavioral health complaints.

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  Figure 2 Emergency department (ED) layout, including the secure patient care area dedicated to patients with behavioral health complaints, adjacent patient care locations (“Area C”), and the decontamination area, which serves as the primary overflow when the number of patients with behavioral health complaints exceeds the space available in secure patient areas.

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  Figure 3 Simio measure of risk and error (SMORE) plot, showing the number of days each year with overflow of patients with behavioral health complaints exceeding the capacity of secure patient care areas. The model outputs for our existing system, as well as models with universal emergency department (ED) screening and universal hospital-wide screening, are represented as a box-and-whisker plot demonstrating the differences in expected unit overflow between these models. The means are presented as orange circles, 95% confidence intervals (CIs) around means are represented by beige bars, and 95% CIs around the 25th and 75th percentiles are represented by blue bars.

Reference

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