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Thanks for this. Dr. Gaurisco has a great command of the subject. In addressing demand variation I’ve done my own studies that show variation in ED patient care needs of plus or minus 150% at the same time of day and day of week over a six month period.
Another way I describe why the ED is such a difficult place is that it is inherently unstable because of transient bottlenecks that we purposefully introduce into the ED in the pursuit of “efficiency” for each resource.
He also framed well his recommendation that we either reduce utilization, improve throughput, or increase resources.