The increasing demand for hospital emergency services has important implications for the allocation of limited public resources and the management of healthcare services. Although reform is an oft-cited way to improve the healthcare system, it has a limited ability to readily address this increasing demand. This paper presents an innovative approach to identify and translate feasible solutions to improve the efficiency of hospitals. Premised on visual analytics, the paper describes the way a software program was used to represent sonography department processes within a virtual environment. The processes were represented by collecting and assembling information about room capacity, room use, patient-scheduling practices, staff capacity, and equipment availability. The resulting model helped to identify areas for improvement and simulate viable options to improve these areas. This was associated with two clear benefits - it allowed solutions to be considered without making changes to the physical environment, and it provided a way to clearly demonstrate to staff the relationship between process change and improved efficiency. The paper concludes with directions for future research.
Key words: Visual analytics, health services, management, innovation, emergency departments, patient flow
In many Western nations, the demand for hospital services is increasing , fuelling public concern that the healthcare system is in crisis , . Increased demand is particularly evident within emergency departments (EDs) . In Australia for instance, there were approximately 6.7 million presentations to EDs in a recent 12-month period  - this represents an increase of 400,000 patients from the previous year . However, Australian public hospitals have a limited capacity to meet this demand .
The limited capacity of EDs is evidenced by access block , . According to the Australian Council on Healthcare Standards and Australasian College for Emergency Medicine (ACHS-ACEM) , access block occurs when a patient remains in an ED for over eight hours, consequent to the limited availability of an inpatient bed. Although international statistics are limited, an examination of Australian data suggests that thirty to forty percent of emergency patients exceed this eight-hour limit . Given that the functionality of an ED degrades once access block exceeds ten percent, this statistic constitutes a serious concern.
The consequences of access block are costly. In addition to increasing risk to patient health , , , it affects the allocation of limited public resources and the management of healthcare services. More specifically, it is associated with decreased efficiency in the ED , , ,  and increased inpatient stays . Given the interconnected nature of hospital departments, access block is likely to hinder patient flow throughout a hospital . As such, it can reduce the efficiency of the surgical, intensive care, pharmaceutical, and diagnostic imaging departments, among others.
The causes of access block are multifaceted. In addition to an insufficient number of inpatient beds , access block is attributed to limited workforce capacity; an ageing population; the increasing number of young patients (under 25 years) who access EDs as a substitute for primary care , ; the increasing number of patients requiring intense and/or continued hospital treatment , thus overcrowding hospital departments ; a decline in community services including nursing homes and mental health services, which in turn adds further strain on the hospital system ; changing patient expectations, largely consequent to improved access to health information; changing referral patterns - for instance, 86 percent of patients in the Australian state of New South Wales (NSW) self-refer to EDs; increased use of ambulance services, which has risen by 10 percent annually in the last two years; the limited access of day clinics and private practitioners ; the decline in bulk billing among general practitioners , , , , particularly in rural areas , , ; and funding arrangements that focus on elective surgery and outpatient care . …