  Emergency Department (ED) overcrowding continues to be a public health issue
as well as a patient safety issue. The underlying factors leading to ED
crowding are numerous, varied, and complex. Although lack of in-hospital beds
is frequently attributed as the primary reason for crowding, ED's dependencies
on other ancillary resources, including imaging, consults, and labs, also
contribute to crowding. Using retrospective data associated with imaging,
including delays, processing time, and the number of image orders, from a large
tier 1 trauma center, we developed a discrete event simulation model to
identify the impact of the imaging delays and bundling image orders on patient
time in the ED. Results from sensitivity analysis show that reducing the delays
associated with imaging and bundling as few as 10% of imaging orders for
certain patients can significantly (p-value < 0.05) reduce the time a patient
spends in the ED.
