A hybrid model to support decision making in emergency department management

The Emergency Department (ED) plays a key role in restoring the health of patients. Ensuring the availability of the ED and achieving rational use of its resources is critical to avoiding ED overcrowding by patients. Given this, the critical question is how ED managers can design and select improvement actions that reduce ED overcrowding. Designing and selecting enhancement actions are viewed as a Multiple Criteria Decision Making (MCDM) problem. Thus, this work provides a hybrid MCDM model combining Decision-Making Trial and Evaluation Laboratory (DEMATEL) and Preference Ranking Organization (PROMETHEE II) methods to help ED managers design improvement actions and make decisions that reduce ED overcrowding. In the model, the role of DEMATEL method is to generate knowledge to support the design of improvement actions from the causal relationships among the criteria governing the management of the patient care and treatment process in ED units. However, as EDs have costly resources, actions need to be prioritized. Therefore, the PROMETHEE II method composes the model to prioritize improvement actions that reduce short-term ED overcrowding. The model was validated by applying it in the ED of one of the largest hospitals in the state of Paraná, Brazil, that exclusively serves patients with the Brazilian federal government’s single healthcare system (Sistema Único de Saúde — SUS). The model was easily understood by the ED managers due to its ease of use, and the integration among these managers necessitated by its development and application enriched the discussion of the overcrowding problem faced by the ED. •Criteria governing the Emergency Department (ED) are identified.•Through DEMATEL, improvement actions are designed to reduce ED overcrowding.•Through the PROMETHEE method, improvement actions are prioritized.•The hybrid model systematized the decision-making process to reduce ED overcrowding.•ED managers could rely on the hybrid model to make efficient decisions.