Digital innovation to improve quality of care in the Emergency Department: A Multi-Method Study

Abstract

Emergency departments (EDs) are vital parts of healthcare systems. However, they often encounter operational challenges, such as overcrowding, long wait times, and inefficient resource utilisation. In the United Kingdom, the National Health Service (NHS) has prioritised reducing patient wait times and improving care quality by setting a goal to treat 76% of ED patients within four hours. This research addresses these challenges by developing and evaluating simulation-based strategies to optimise ED operations performance and enhance care quality. The thesis employed a sequential mixed-methods approach. It began with a systematic literature review to identify gaps in applying mathematical and simulation models in ED settings. This was followed by cross-sectional data analysis and direct non-participant observations at University Hospital Southampton (UHS), aimed at understanding patient pathways, operational bottlenecks, and key performance indicators. Discrete Event Simulation (DES) was then used to replicate the department’s operational dynamics and evaluate the impact of potential interventions. The simulation results indicated that a combination of resource and process improvements increased the percentage of patients treated within four hours from 43.83% to 76.05%. The most effective interventions included adding a second triage room and nurse to reduce front-end delays, reducing laboratory turnaround time by 20%, and increasing clinical staff from five to six, nurses from 15 to 19, and healthcare assistants from 16 to 19, all of which collectively enhanced patient flow and care delivery across the ED. This thesis contributes to academic and practical understanding by presenting a validated simulation framework that supports evidence-based decision-making. The findings offer healthcare managers and policymakers a robust, low-risk method for evaluating and implementing targeted interventions without disrupting real-world operations. By addressing systemic inefficiencies and promoting patient-centred strategies, the study supports broader NHS objectives to improve the quality and responsiveness of emergency care.