Developing an emergency department crowding dashboard: A design science approach.

BACKGROUND: As an emergency department (ED) is a complex adaptive system, the analysis of continuously gathered data is valuable to gain insight in the real-time patient flow. To support the analysis and management of ED operations, relevant data should be provided in an intuitive way. AIM: Within this context, this paper outlines the development of a dashboard which provides real-time information regarding ED crowding. METHODS: The research project underlying this paper follows the principles of design science research, which involves the development and study of artifacts which aim to solve a generic problem. To determine the crowding indicators that are desired in the dashboard, a modified Delphi study is used. The dashboard is implemented using the open source Shinydashboard package in R. RESULTS: A dashboard is developed containing the desired crowding indicators, together with general patient flow characteristics. It is demonstrated using a dataset of a Flemish ED and fulfills the requirements which are defined a priori. CONCLUSIONS: The developed dashboard provides real-time information on ED crowding. This information enables ED staff to judge whether corrective actions are required in an effort to avoid the adverse effects of ED crowding.

Utilizing a scope and span of control tool to measure workload and determine supporting resources for nurse managers.

The scope and span of control of the nurse manager directly impact turnover, succession planning, and satisfaction. Measuring and benchmarking scope and span of control remain a challenge. An interprofessional team across an integrated health delivery system developed and implemented such a tool, which was used to determine the amount of operational and clerical support for managers. Since implementation, there has been a decrease in turnover and time to fill nurse manager positions.