Emergency department crowding in Singapore: Insights from a systems thinking approach.

dc.contributor.author

Schoenenberger, Lukas K

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Bayer, Steffen

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Ansah, John P

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Matchar, David B

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Mohanavalli, Rajagopal L

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Lam, Sean Sw

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Ong, Marcus Eh

dc.date.accessioned

2021-05-05T08:36:32Z

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2021-05-05T08:36:32Z

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2016-01

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2021-05-05T08:36:31Z

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Objectives

Emergency Department crowding is a serious and international health care problem that seems to be resistant to most well intended but often reductionist policy approaches. In this study, we examine Emergency Department crowding in Singapore from a systems thinking perspective using causal loop diagramming to visualize the systemic structure underlying this complex phenomenon. Furthermore, we evaluate the relative impact of three different policies in reducing Emergency Department crowding in Singapore: introduction of geriatric emergency medicine, expansion of emergency medicine training, and implementation of enhanced primary care.

Methods

The construction of the qualitative causal loop diagram is based on consultations with Emergency Department experts, direct observation, and a thorough literature review. For the purpose of policy analysis, a novel approach, the path analysis, is applied.

Results

The path analysis revealed that both the introduction of geriatric emergency medicine and the expansion of emergency medicine training may be associated with undesirable consequences contributing to Emergency Department crowding. In contrast, enhancing primary care was found to be germane in reducing Emergency Department crowding; in addition, it has apparently no negative side effects, considering the boundary of the model created.

Conclusion

Causal loop diagramming was a powerful tool for eliciting the systemic structure of Emergency Department crowding in Singapore. Additionally, the developed model was valuable in testing different policy options.
dc.identifier

10.1177_2050312116671953

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2050-3121

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2050-3121

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https://hdl.handle.net/10161/22822

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eng

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SAGE Publications

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SAGE open medicine

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10.1177/2050312116671953

dc.subject

Critical care/emergency medicine

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Emergency Department crowding

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causal loop diagramming

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modelling

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path analysis

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policy analysis

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systems thinking

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Emergency department crowding in Singapore: Insights from a systems thinking approach.

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Journal article

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Matchar, David B|0000-0003-3020-2108

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2050312116671953

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School of Medicine

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Duke Clinical Research Institute

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Duke Global Health Institute

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Pathology

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Medicine, General Internal Medicine

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Duke

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Institutes and Centers

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University Institutes and Centers

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Institutes and Provost's Academic Units

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Clinical Science Departments

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Medicine

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Published

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4

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