Tabletop exercises as an adjunct to emergency department operations

Acute unscheduled care in seven developed nations

Philips has sponsored an in-depth assessment of acute unscheduled care, the demands on acute care providers, and use of the emergency department across 7 countries. This research paper explores the similarities and differences in the factors leading to acute unscheduled care demands, care decision making, and care delivery in the ED and beyond.


Trends in healthcare management

Tabletop exercises have been utilized within the healthcare setting for emergency management planning for over 10 years.* These exercises simulate a situation in an informal, stress-free environment.* Participants in these exercises are decision makers, stakeholders, and persons with key information, who carry out scenarios and discuss general problems, procedures, changes and solutions.* The usefulness of this type of exercise can extend past emergency management.

* Federal Emergency Management Agency, 2003
Emergency departments can utilize tabletop exercises to simulate different patient throughput scenarios and alternatives to those scenarios. Furthermore, these exercises can also be modified into a tool to aid in interviewing potential charge nurse and patient flow or throughput nurse candidates.

There are tangible advantages to utilizing a tabletop exercise as a first step in implementing process change related to ED flow. Tabletops only require a small commitment of time and financial resources (FEMA, 2003). They are also an effective tool for reviewing current processes, plans, procedures, and policies, and are non-invasive to staff and patients within the department (FEMA, 2003).

However, there are also disadvantages to tabletop flow simulation in the ED. The exercises can lack realism of the actual event and may not sufficiently simulate challenges that are experienced in an actual event (FEMA, 2003). While conducting a patient throughput scenario, processes like bed turnover, staff meal breaks, transport time, and charge nurse distractions are difficult to simulate.
Other models to simulate patient throughput exist. The use of computer model simulation provides a quantitative tool for hospital and department leadership and staff to model different procedures such as staffing models, triage models or throughput models (Wang, Li, Tussey & Ross, 2012). Computer simulation can provide a wealth of statistical data and analysis about process changes; however, the models are time intensive and typically require specialized software and staff that can be costly (Brenner et al., 2010).

Utilizing tabletop exercises assist departments that struggle with throughput strategies by allowing for the adjustment of multiple variables during one or more simulations.

Our approach

These exercises have provided benefit in a large metropolitan emergency department as a first step to department throughput process improvement and as a tool for charge nurse interviews. The same process could potentially be utilized in other emergency departments with similar challenges and additional tabletop exercises could also be designed to improve other processes within the emergency department and hospital.

Download the full white paper to learn more about how table top exercises can be easily adapted to also improve operational efficiencies and training within emergency departments.


Brenner, S., Zeng, Z., Liu, Y., Wang, J., Li, J., & Howard, P. (2010, July. Modeling and analysis of the emergency department at University of Kentucky Chandler Hospital using simulations. Journal of Emergency Nursing, 36, 303-310.

Federal Emergency Management Agency. (2003). Unit 5: The Tabletop Exercise. Emergency Management Institute: Exercise Design IS-139.

Wang, J., Li, J., Tussey, K., & Ross, K. (2012, November). Reducing length of stay in emergency department: A simulation study at a community hospital. IEEE Transactions on Systems, Man, and Cybernetics, 42, 1314-1322.

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