Computer Simulation to Assess Emergency Department Length of Stay in Pediatric Traumatic Brain Injury

Tianshu Feng, Ali Ajdari, Linda Ng Boyle, Nithya Kannan, Randall Burd, Jonathan I. Groner, R. Austin Farneth, Monica S. Vavilala

Research output: Contribution to journalArticlepeer-review


Objectives Our study aimed to identify how emergency department (ED) arrival rate, process of care, and physical layout can impact ED length of stay (LOS) in pediatric traumatic brain injury care. Methods Process flows and value stream maps were developed for 3 level I pediatric trauma centers. Computer simulation models were also used to examine "what if"scenarios based on ED arrival rates. Results Differences were observed in prearrival preparation time, ED physical layouts, and time spent on processes. Shorter prearrival preparation time, trauma bed location far from diagnostic or treatment areas, and ED arrival rates that exceed 20 patients/day prolonged ED LOS. This was particularly apparent in 1 center where computer simulation showed that relocation of trauma beds can reduce ED LOS regardless of the number of patients that arrive per day. Conclusions Exceeding certain threshold ED arrival rates of children with traumatic brain injury can substantially increase pediatric trauma center ED LOS but modifications to ED processes and bed location may mitigate this increase.

Original languageEnglish (US)
Pages (from-to)421-425
Number of pages5
JournalPediatric Emergency Care
Issue number6
StatePublished - Jun 1 2024


  • process flow maps
  • simulation models
  • traumatic brain injury

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine


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