Cross-Training Policies for Enhanced Resilience in Emergency Departments

This paper investigates cross-training policies to enhance emergency department resilience in managing patient demand surges. We evaluated operational performance under varying patient flows using a simulation model based on an emergency department in Abu Dhabi, UAE. Results demonstrated a significant increase in patient length of stay in the triage room due to a shortage of available nurses during surges. Conversely, nurses in other areas (adult zone, pediatrics, and fast-track) were less affected. Two cross-training policies were investigated: pooling nurses from the triage and adult zones and expanding the pool to include the pediatrics section. The first policy reduced patient length of stay in the triage by 91.71%. The second policy further improved flexibility, leading to reductions in length of stay. Additional experiments revealed the limitations of the second policy when subjected to higher surge levels; therefore, further research is needed to explore a broader range of policies and contexts.