How resilient is your emergency department to inflow surges? A novel multidimensional framework for resilience enhancement

Emergency Departments (EDs) encounter numerous operational challenges, uncertainties, and sudden surges in patient arrivals, often resulting in overcrowding. This overcrowding can impact patient outcomes, staff satisfaction, and the overall functionality of the system. Therefore, it is crucial to strengthen the resilience of these departments in the face of such uncertainties. In this study, we aim to identify the key factors contributing to ED overcrowding and develop a comprehensive hierarchical multidimensional resilience model. This model categorizes the components of three crowding assessment tools: NEDOCS, EDWIN, and READI, into two main categories, recoverability and resistance. The proposed approach demonstrates promising results as we apply it to examine three case studies using Discrete Event Simulation (DES). The subsequent phase involves providing strategic recommendations to improve the ED's performance and serves as a valuable tool for proactive system failure prevention. These recommendations encompass augmenting available resources and optimizing patient pathways, all aimed at enhancing the ED's ability to operate effectively. Our findings underscore the accuracy of the DES model in predicting the ED system's performance under various conditions, ranging from normal patient influx scenarios to high patient influx scenarios. This generalizable hierarchical resilience model aids decision-makers in comprehending system factors for better resource allocation and management decisions.