Modelling patient flow through hospital emergency departments: a framework for generalisable discrete event simulation modelling using Coxian distributions

Overcrowding is a frequent occurrence, caused by a combination of high presentation numbers, insufficient resources within emergency departments, and long delays in the transfer or discharge of patients due to a lack of availability of hospital beds and care in the community. Frequent breaches of time-based performance targets are reported in a wide range of national healthcare systems, including the UK and Australia, which are the particular focus of this work.

These issues are projected to intensify, as emergency department numbers continue to climb - in Australia, at a rate of 3.7% annually. Budgetary constraints mean that straightforward solutions, such as increasing resource capacity, are often infeasible. Modelling and simulation techniques can therefore play an essential role in the detection and improvement of patient flow- related issues.