Analysis of emergency department waiting lines
Abstract
Background: Steady increase in the numbers of patients seeking medical assistance has recently been observed at the emergency department of the health center under study. This has led to increases in waiting times for patients. The management of the health center has been considering to implement certain measures to remedy this situation. One proposed solution is to add an additional physician to the emergency department. A computer model was constructed to simulate waiting lines and analyze the economic feasibility of employing an additional physician.
Aim: This paper analyzes the waiting lines at the emergency department and performs an economic feasibility study to determine whether adding an additional physician to the department would be economically justified.
Methods: Data about waiting times at the emergency department were collected to study the situation. For each patient, the arrival time at the waiting room and the starting and ending times of the examination were registered. The data were collected from 13 June 2011 to 25 September 2011. The sample included data on 65 nightly standbys, nine standbys on Saturdays, and 16 standbys on Sundays. Due to incomplete entries, data for nine weekly standbys and six Saturday standbys were excluded from the sample. Based on the data collected, we calculated the waiting and examination times per patient, average number of patients, average waiting time, average examination time, share of active standby teams in total standby time, and number of patients in different time periods. The study involved 1,039 patients. Using a synthesis method, we designed a computer model of waiting lines and economic feasibility. The model was validated using comparative analysis. A what-if analysis was performed using various computer simulations with various scenarios to consider the outcomes of decision alternatives. We applied economic analysis to select the best possible solution.
Results: The research results show that emergency department teams face overcrowding at certain periods. This is particularly challenging for employees performing 24-hour standbys, when they are working at the limit of their capacity. The results show that the total cost of waiting lines with two physicians is higher in all cases. The introduction of an additional channel or employing an additional physician increases the total cost by 35 to 50 %. Employing an additional physician is therefore not economically justified.
Conclusion: This study showed how a computer model can be used to improve the information basis for decision-making in healthcare organization management. Based on quantitative data obtained by using a model with alternative scenarios, we developed an economic analysis of alternatives and made a decision. The cost analysis of potentially employing an additional physician showed that the cost would exceed the benefits obtained in all scenarios analyzed. The proposed decision-support method can be implemented at a very low cost in all healthcare organizations dealing with similar problems.
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References
Cabrera E, Taboada M, Iglesias M L, Epelde F, Luque E. Optimization of healthcare emergency departments by agent – based simulation. Procedia computer science 2011, 4: 1880–9.
Občina Idrija. Statistični urad RS Nov 2013. Dosegljivo na http://www.stat.si/ObcineVStevilkah/Vsebina.aspx?leto=2013&id=52
Občina Cerkno. Statistični urad RS Nov 2013. Dosegljivo na http://www.stat.si/ObcineVStevilkah/Vsebina.aspx?leto=2013&id=19
Welch S J, Asplin B R, Stone-Griffith S, Davidson S J, Augustine J, Schuur J. Emergency department operational metrics, measures and definitions: Results of the second performance measures and benchmarking summit. Annals of Emergency Medicine 2011, 58(1): 33–40.
Rao S, Gunasekaran A, Goyal, S K, Martikainen, T. Waiting line model applications in manufacturing. International Journal of Production Economics 1998, 54(1): 1–28.
Godden S, Pollock A M. Waiting list and waiting time statistics in Britain: A critical review. Public Health 2009, 123(1): 47–51.
Anderson D R, Sweeney D J, Williams T A. An introduction to management science. Mason: Thomson/South-Western Learning; 2005.
Winston W L, Albright S C. Practical management science. Mason: Thomson Higher Education; 2007.
Bicheno J. The lean toolbox for service systems. Buchingham: Picsie Books; 2008.
Goddard J, Tavakoli M. Efficiency and welfare implications of managed public sector hospital waiting lists. European journal of operational research 2008, 184(2): 778–92.
Rotstein D L, Alter D A. Where does the waiting list begin? A short review of the dynamics and organization of modern waiting lists. Social Science and Medicine 2006, 62(12): 3157–60.
Cochran J K, Broyles J R. Developing nonlinear queuing regressions to increase emergency department patient safety: Approximating reneging with balking. Computers & Industrial Engineering 2010, 59(3): 378–86.
Schull M J, Kiss A, Szalai J P. The effect of low-complexity patients on emergency department waiting times. Annals of Emergency Medicine 2007, 49(3): 257–264.
Wellstood K, Wilson K, Eyles J. Unless you went in with your head in your arm”: Patient perceptions of emergency room visits. Social Science and Medicine 2005, 61(11): 2363–73.
Hoot N R, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Annals of Emergency Medicine 2008, 52(2): 126–136.
Holden R J. Lean thinking in emergency departments: a critical review. Annals of Emergency Medicine 2010, 57(3): 265–278.
Dieter B, Gentile D. Improving clinical practices can boost the bottom line. Healthcare Financial Management 1995, 4(9): 38–41.
Willer J L, Gentle C, Halfpenny J M, Heins A, Mehrota A, Mikhail M G, Fite D. Optimizing emergency department front-end operations. Annals of Emergency Medicine 2010, 55(2): 142–160.
Eitel D R, Rudkin S E, Malvehy M A, Killeen J P, Pines J M. Improving service quality by understanding emergency department flow: a white paper and position statement prepared for the American academy of emergency medicine. The Yournal of Emergency Medicine 2008, 38(1): 70–79.
Creswick N, Westbrook J I, Braithwaite J. Understanding communication networks in the emergency department. BMC Health Services Research 2009, 9(1): 247–56.
Carranza M E O, Villarreal R E, Daza V E R, Rodríguez G L, González M L. Opportunity cost for men who visit family medicine units in the city of Querétaro, Mexico. Pan American journal of public health; 2010, 28(6): 456–62.
Schulman J D. Potential effects of opportunity cost on dental school patients. Journal of Dental Education 1996, 60(3): 693–700.
Taylor I D S, Tepleton J G C. Waiting Time In a Multi-Server Cutoff-Priority Queue, and Its Application to an Urban Ambulance Service. Operations Research 1980, 28(5): 1168–88.
Singer M, Donoso P. Assessing an ambulance service with queing theory. Computers & Operations Research 2008, 35(8): 2549–60.
Laskowski M, McLeod R D, Friesen M R, Podaima B W, Alfa A S. Models of Emergency Departments for Reducing Patient Waiting Times. PLoS ONE 2009, 4(7): 6127.
Kolker A. Process Modeling of Emergency Departmen Patient Flow: Effect of Patient Length of Stay on ED Diversion. Journal of Medical Systems 2008, 32(5): 389–401.
Wang G. Modeling and Analysis of High Risk Patient Queues. European Journal of Operational Research 2004, 2(1): 502–15.
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