On 2014 Apr 16, T Eugene Day commented:

This is a very interesting study that uses DES to examine a generic ED model and assess the impact of discharge strategies on length of stay and readmission rates. Though the described model itself is fairly rudimentary with regard to care processes, it shows reasonable accordance to published throughput data, and I was pleased to see that the authors made a point of including their methods of validation, which is too frequently glossed-over, or omitted, in healthcare-based DES work. The bounds on the real-world values obtained from the literature and their expert panel were very large. However, real world variation in LOS is very large, and using expert panels when necessary is appropriate in validation. Ideally, it would be nice to compare the simulation to prospectively gathered multi-site data, but I recognize that that's a high bar to set.

Given the general nature of the simulation, the authors make appropriate conclusions with regard to crowding, and readmissions. With regard to the influence of the discharge strategy on individual patient outcomes, it is of course plausible that this is true, but I am reluctant to draw such a conclusion from simulation alone.

On the whole, an excellent article demonstrating the strength of using DES to glean insight into systemic behavior.

On 2014 Apr 16, T Eugene Day commented:

This is a very interesting study that uses DES to examine a generic ED model and assess the impact of discharge strategies on length of stay and readmission rates. Though the described model itself is fairly rudimentary with regard to care processes, it shows reasonable accordance to published throughput data, and I was pleased to see that the authors made a point of including their methods of validation, which is too frequently glossed-over, or omitted, in healthcare-based DES work. The bounds on the real-world values obtained from the literature and their expert panel were very large. However, real world variation in LOS is very large, and using expert panels when necessary is appropriate in validation. Ideally, it would be nice to compare the simulation to prospectively gathered multi-site data, but I recognize that that's a high bar to set.

Given the general nature of the simulation, the authors make appropriate conclusions with regard to crowding, and readmissions. With regard to the influence of the discharge strategy on individual patient outcomes, it is of course plausible that this is true, but I am reluctant to draw such a conclusion from simulation alone.

On the whole, an excellent article demonstrating the strength of using DES to glean insight into systemic behavior.