scholarly journals Robust capacity planning for accident and emergency services

2020 ◽  
Vol 54 (6) ◽  
pp. 1757-1773
Author(s):  
Elvan Gökalp
Keyword(s):  
Capacity Planning ◽  
Emergency Services ◽  
Simulation Optimization ◽  
Patient Flow ◽  
Waiting Times ◽  
Model Parameters ◽  
Planning Problem ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
The Impact

Accident and emergency departments (A&E) are the first place of contact for urgent and complex patients. These departments are subject to uncertainties due to the unplanned patient arrivals. After arrival to an A&E, patients are categorized by a triage nurse based on the urgency. The performance of an A&E is measured based on the number of patients waiting for more than a certain time to be treated. Due to the uncertainties affecting the patient flow, finding the optimum staff capacities while ensuring the performance targets is a complex problem. This paper proposes a robust-optimization based approximation for the patient waiting times in an A&E. We also develop a simulation optimization heuristic to solve this capacity planning problem. The performance of the approximation approach is then compared with that of the simulation optimization heuristic. Finally, the impact of model parameters on the performances of two approaches is investigated. The experiments show that the proposed approximation results in good enough solutions.

scholarly journals Applying quality improvement principles to improve accident and emergency department overcrowding and flow in Rwanda: a case study

2015 ◽  
Vol 4 (5) ◽  
pp. 47 ◽  
Author(s):  
Jean Claude Byiringiro ◽  
Rex Wong ◽  
Caroline Davis ◽  
Jeffery Williams ◽  
Joseph Becker ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Improvement ◽  
Success Factors ◽  
Low Cost ◽  
Post Intervention ◽  
Triage System ◽  
Accident And Emergency ◽  
Number Of Patients ◽  
Accident And Emergency Department ◽  
The Impact

Few case studies exist related to hospital accident and emergency department (A&E) quality improvement efforts in lowerresourced settings. We sought to report the impact of quality improvement principles applied to A&E overcrowding and flow in the largest referral and teaching hospital in Rwanda. A pre- and post-intervention study was conducted. A linked set of strategies included reallocating room space based on patient/visitor demand and flow, redirecting traffic, establishing a patient triage system and installing white boards to facilitate communication. Two months post-implementation, the average number of patients boarding in the A&E hallways significantly decreased from 28 (pre-intervention) to zero (post-intervention), p < .001. Foot traffic per dayshift hour significantly decreased from 221 people to 160 people (28%, p < .001), and non-A&E related foot traffic decreased from 81.4% to 36.3% (45% decrease, p < .001). One hundred percent of the A&E patients have been formally triaged since the implementation of the newly established triage system. Our project used quality improvement principles to reduce the number of patients boarding in the hallways and to decrease unnecessary foot traffic in the A&E department with little investment from the hospital. Key success factors included a collaborative multidisciplinary project team, strong internal champions, data-driven analysis, evidence-based interventions, senior leadership support, and rapid application of initial implementation learnings. Results to date show the application of quality improvement principles can help hospitals in resource-limited settings improve quality of care at relatively low cost.

Enhancing patient flow in emergency department (ED) using lean strategies–an integrated voice of customer and voice of process perspective

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ali Alowad ◽  
Premaratne Samaranayake ◽  
Kazi Ahsan ◽  
Hisham Alidrisi ◽  
Azharul Karim
Keyword(s):  
Waiting Time ◽  
Emergency Services ◽  
Single Case ◽  
Patient Flow ◽  
Waiting Times ◽  
Small Sample ◽  
Content Type ◽  
Lean Tools ◽  
And Performance ◽  
Voice Of Customer

PurposeThe purpose of this paper is to systematically investigate the patient flow and waiting time problems in hospital emergency departments (EDs) from an integrated voice of customer (VOC) and voice of process (VOP) perspective and to propose a new lean framework for ED process.Design/methodology/approachA survey was conducted to better understand patients' perceptions of ED services, lean tools such as process mapping and A3 problem-solving sheets were used to identify hidden process wastes and root-cause analysis was performed to determine the reasons of long waiting time in ED.FindingsThe results indicate that long waiting times in ED are major concerns for patients and affect the quality of ED services. It was revealed that limited bed capacity, unavailability of necessary staff, layout of ED, lack of understanding among patients about the nature of emergency services are main causes of delay. Addressing these issues using lean tools, integrated with the VOC and VOP perspectives can lead to improved patient flow, higher patient satisfaction and improvement in ED capacity. A future value stream map is proposed to streamline the ED activities and minimize waiting times.Research limitations/implicationsThe research involves a relatively small sample from a single case study. The proposed approach will enable the ED administrators to avoid the ED overcrowding and streamline the entire ED process.Originality/valueThis research identified ED quality issues from the integration of VOC and VOP perspective and suggested appropriate lean tools to overcome these problems. This process improvement approach will enable the ED administrators to improve productivity and performance of hospitals.

scholarly journals A System-Based Intervention to Improve Access to Hyperacute Stroke Care

2017 ◽  
Vol 44 (5) ◽  
pp. 475-482 ◽  
Author(s):  
Richard H. Swartz ◽  
Elizabeth Linkewich ◽  
Shelley Sharp ◽  
Jacqueline Willems ◽  
Chris Olynyk ◽  
...  
Keyword(s):  
Patient Flow ◽  
Stroke Care ◽  
Hyperacute Stroke ◽  
Greater Toronto Area ◽  
Number Of Patients ◽  
Tissue Plasminogen ◽  
Incident Reports ◽  
The Impact ◽  
Mean Time ◽  
Improve Access

AbstractBackground:Hyperacute stroke is a time-sensitive emergency for which outcomes improve with faster treatment. When stroke systems are accessed via emergency medical services (EMS), patients are routed to hyperacute stroke centres and are treated faster. But over a third of patients with strokes do not come to the hospital by EMS, and may inadvertently arrive at centres that do not provide acute stroke services. We developed and studied the impact of protocols to quickly identify and move “walk-in” patients from non-hyperacute hospitals to regional stroke centres (RSCs).Methods and Results:Protocols were developed by a multi-disciplinary and multi-institutional working group and implemented across 14 acute hospital sites within the Greater Toronto Area in December of 2012. Key metrics were recorded 18 months pre- and post-implementation. The teams regularly reviewed incident reports of protocol non-adherence and patient flow data. Transports increased by 80% from 103 to 185. The number of patients receiving tissue plasminogen activator (tPA) increased by 68% from 34 to 57. Total EMS transport time decreased 17 minutes (mean time of 54.46 to 37.86 minutes,p<0.0001). Calls responded to within 9 minutes increased from 34 to 59%.Conclusions:A systems-based approach that included a multi-organizational collaboration and consensus-based protocols to move patients from non-hyperacute hospitals to RSCs resulted in more patients receiving hyperacute stroke interventions and improvements in EMS response and transport times. As hyperacute stroke care becomes more centralized and endovascular therapy becomes more broadly implemented, the protocols developed here can be employed by other regions organizing patient flow across systems of stroke care.

scholarly journals Employment of Emergency Advanced Nurses of Turkey: A Discrete-Event Simulation Application

Processes ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 48 ◽  
Author(s):  
Abdulkadir Atalan ◽  
Cem Donmez
Keyword(s):  
Length Of Stay ◽  
Discrete Event Simulation ◽  
Emergency Services ◽  
Treatment Time ◽  
Waiting Times ◽  
Discrete Event ◽  
Weekly Basis ◽  
Event Simulation ◽  
Number Of Patients ◽  
Efficiency Rate

In the present study, problems in emergency services (ESs) were dealt with by analyzing the working system of ESs in Turkey. The purpose of this study was to reduce the waiting times spent in hospitals by employing advanced nurses (ANs) to treat patients who are not urgent, or who may be treated as outpatients in ESs. By applying discrete-event simulation on a 1/24 (daily) and 7/24 (weekly) basis, and by employing ANs, it was determined that the number of patients that were treated increased by 26.71% on a 1/24 basis, and by 15.13% on a 7/24 basis. The waiting time that was spent from the admission to the ES until the treatment time decreased by 38.67% on a 1/24 basis and 53.66% on a 24/7 basis. Similarly, the length of stay was reduced from 82.46 min to 53.97 min in the ES. Among the findings, it was observed that the efficiency rate of the resources was balanced by the employment of ANs, although it was not possible to obtain sufficient efficiency from the resources used in the ESs prior to the present study.

scholarly journals Are service and patient indicators different in the presence or absence of nurse practitioners? The EDPRAC cohort study of Australian emergency departments

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e024529
Author(s):  
Sandy Middleton ◽  
Glenn Gardner ◽  
Anne Gardner ◽  
Julie Considine ◽  
Gerard Fitzgerald ◽  
...  
Keyword(s):  
Cohort Study ◽  
Nurse Practitioners ◽  
Quality Indicator ◽  
Emergency Departments ◽  
Proportional Hazards ◽  
Waiting Times ◽  
Cox Proportional Hazards ◽  
Number Of Patients ◽  
Indicator Data ◽  
The Impact

ObjectivesTo evaluate the impact of nurse practitioner (NP) service in Australian public hospital emergency departments (EDs) on service and patient safety and quality indicators.Design and settingCohort study comprising ED presentations (July 2013–June 2014) for a random sample of hospitals, stratified by state/territory and metropolitan versus non-metropolitan location; and a retrospective medical record audit of ED re-presentations.MethodsService indicator data (patient waiting times for Australasian Triage Scale categories 2, 3, 4 and 5; number of patients who did not-wait; length of ED stay for non-admitted patients) were compared between EDs with and without NPs using logistic regression and Cox proportional hazards regression, adjusting for hospital and patient characteristics and correlation of outcomes within hospitals. Safety and quality indicator data (rates of ED unplanned re-presentations) for a random subset of re-presentations were compared using Poisson regression.ResultsOf 66 EDs, 55 (83%) provided service indicator data on 2 463 543 ED patient episodes while 58 (88%) provided safety and quality indicator data on 2853 ED re-presentations. EDs with NPs had significantly (p<0.001) higher rates of waiting times compared with EDs without NPs. Patients presenting to EDs with NPs spent 13 min (8%) longer in ED compared with EDs without NPs (median, (first quartile–third quartile): 156 (93–233) and 143 (84–217) for EDs with and without NPs, respectively). EDs with NPs had 1.8% more patients who did not wait, but similar re-presentations rates as EDs with NPs.ConclusionsEDs with NPs had statistically significantly lower performance for service indicators. However, these findings should be treated with caution. NPs are relatively new in the ED workforce and low NP numbers, staffing patterns and still-evolving roles may limit their impact on service indicators. Further research is needed to explain the dichotomy between the benefits of NPs demonstrated in individual clinical outcomes research and these macro system-wide observations.

scholarly journals (A181) Process Improvement in Disaster Relief: Implementation of a Fast Track in a Haitian Tent Hospital

2011 ◽  
Vol 26 (S1) ◽  
pp. s51-s51 ◽  
Author(s):  
C. Bloem ◽  
R. Gore ◽  
B. Arquilla ◽  
T. Naik ◽  
J. Schechter
Keyword(s):  
Fast Track ◽  
Disaster Relief ◽  
Medical Center ◽  
Patient Flow ◽  
Waiting Times ◽  
Time Of Arrival ◽  
Study Objective ◽  
Use Of Resources ◽  
Number Of Patients ◽  
Track Area

Study ObjectiveTo determine if instituting an Emergency Department (ED) fast-track area would increase efficiency in patient flow, improve utilization of limited resources, and identify critical versus non-critical patients during disaster relief in Port au Prince, Haiti.MethodsA survey was conducted at L'Hôpital de l'Université d'Etat d'Haïti (HUEH) in Port au Prince, Haiti by Emergency physicians and nurses from SUNY Downstate Medical Center on a disaster relief mission following the 2010 earthquake. The following variables were obtained to assess ED effectiveness: number of patients, acuity level, chief complaints, critical interventions, waiting times, length of stay, specialty service coverage and physical plant space. Additionally, existing practitioners were surveyed regarding existing ED practices. ED operation flow maps were created.ResultsThe assessment revealed a large volume of low-acuity patients mixed with high-acuity patients without identification of acuity level, time of arrival, or designated area for treatment. Although literature reports routine use of START triage, this was not being implemented in this setting. Results of implementing a fast track area included: (1) Improved identification of patients needing immediate treatment. (2) Increased flow of low acuity patients in designated fast track areas. (3) Improved triage protocols maximized appropriate use of resources, and expedited subspecialty consultation.ConclusionBy instituting well-accepted, validated patient flow systems and reinforcing communication regarding resources available and the use of geographic space, better management of incoming emergency patients was achieved.

scholarly journals Two-stage battery recharge scheduling and vehicle-charger assignment policy for dynamic electric dial-a-ride services

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251582
Author(s):  
Tai-Yu Ma
Keyword(s):  
Large Scale ◽  
Waiting Times ◽  
Model Parameters ◽  
Two Stage ◽  
Charging Infrastructure ◽  
Solution Approach ◽  
Charging Station ◽  
Total Vehicle ◽  
Vehicle Charging ◽  
The Impact

Coordinating the charging scheduling of electric vehicles for dynamic dial-a-ride services is challenging considering charging queuing delays and stochastic customer demand. We propose a new two-stage solution approach to handle dynamic vehicle charging scheduling to minimize the costs of daily charging operations of the fleet. The approach comprises two components: daily vehicle charging scheduling and online vehicle–charger assignment. A new battery replenishment model is proposed to obtain the vehicle charging schedules by minimizing the costs of vehicle daily charging operations while satisfying vehicle driving needs to serve customers. In the second stage, an online vehicle–charger assignment model is developed to minimize the total vehicle idle time for charges by considering queuing delays at the level of chargers. An efficient Lagrangian relaxation algorithm is proposed to solve the large-scale vehicle-charger assignment problem with small optimality gaps. The approach is applied to a realistic dynamic dial-a-ride service case study in Luxembourg and compared with the nearest charging station charging policy and first-come-first-served minimum charging delay policy under different charging infrastructure scenarios. Our computational results show that the approach can achieve significant savings for the operator in terms of charging waiting times (–74.9%), charging times (–38.6%), and charged energy costs (–27.4%). A sensitivity analysis is conducted to evaluate the impact of the different model parameters, showing the scalability and robustness of the approach in a stochastic environment.

scholarly journals Telehealth to support referral management in a universal health system: a before-and-after study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sabrina Dalbosco Gadenz ◽  
Josué Basso ◽  
Patrícia Roberta Berithe Pedrosa de Oliviera ◽  
Stephan Sperling ◽  
Marcus Vinicius Dutra Zuanazzi ◽  
...  
Keyword(s):  
Linear Models ◽  
Patient Flow ◽  
Waiting Times ◽  
Median Number ◽  
Waiting Lists ◽  
Referral Management ◽  
Before And After ◽  
The Impact ◽  
Universal Health ◽  
Before And After Study

Abstract Background Management of patient flow within a healthcare network, allowing equitable and qualified access to healthcare, is a major challenge for universal health systems. Implementation of telehealth strategies to support referral management has been shown to increase primary care resolution and to promote coordination of care. The objective of this study was to assess the impact of telehealth strategies on waiting lists and waiting times for specialized care in Brazil. Methods Before-and-after study with measures obtained between January 2019 and February 2020. Baseline measurements of waiting lists were obtained immediately before the implementation of a remotely operated referral management system. Post-interventional measurements were obtained monthly, up to six months after the beginning of operation. Data was extracted from the database of the project. General linear models were applied to assess interaction of locality and time over number of cases on waiting lists and waiting times. Results At baseline, the median number of cases on waiting lists ranged from 2961 to 12,305 cases. Reductions of the number of cases on waiting lists after six months of operation were observed in all localities. The magnitude of the reduction ranged from 54.67 to 88.97 %. Interaction of time measurements was statistically significant from the second month onward. Median waiting times ranged from 159 to 241 days at baseline. After six months, there was a decrease of 100 and 114 waiting days in two localities, respectively, with reduction of waiting times only for high-risk cases in the third locality. Conclusions Adoption of telehealth strategies resulted in the reduction of number of cases on waiting lists. Results were consistent across localities, suggesting that telehealth interventions are viable in diverse settings.

scholarly journals Minimizing ED Waiting Times and Improving Patient Flow and Experience of Care

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Assaad Sayah ◽  
Loni Rogers ◽  
Karthik Devarajan ◽  
Lisa Kingsley-Rocker ◽  
Luis F. Lobon
Keyword(s):  
Positive Impact ◽  
Patient Flow ◽  
Waiting Times ◽  
Improvement Project ◽  
Ambulance Diversion ◽  
Experience Of Care ◽  
Left Without Being Seen ◽  
Patient Satisfaction Scores ◽  
Core Measures ◽  
The Impact

We conducted a pre- and postintervention analysis to assess the impact of a process improvement project at the Cambridge Hospital ED. Through a comprehensive and collaborative process, we reengineered the emergency patient experience from arrival to departure. The ED operational changes have had a significant positive impact on all measured metrics. Ambulance diversion decreased from a mean of 148 hours per quarter before changes in July 2006 to 0 hours since April 2007. ED total length of stay decreased from a mean of 204 minutes before the changes to 132 minutes. Press Ganey patient satisfaction scores rose from the 12th percentile to the 59th percentile. ED patient volume grew by 11%, from a mean of 7,221 patients per quarter to 8,044 patients per quarter. Compliance with ED specific quality core measures improved from a mean of 71% to 97%. The mean rate of ED patients that left without being seen (LWBS) dropped from 4.1% to 0.9%. Improving ED operational efficiency allowed us to accommodate increasing volume while improving the quality of care and satisfaction of the ED patients with minimal additional resources, space, or staffing.

scholarly journals Management of non-urgent paediatric emergency department attendances by GPs: a retrospective observational study

2020 ◽  
Vol 71 (702) ◽  
pp. e22-e30
Author(s):  
Simon Leigh ◽  
Bimal Mehta ◽  
Lillian Dummer ◽  
Harriet Aird ◽  
Sinead McSorley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Services ◽  
Waiting Times ◽  
Cost Effective ◽  
Treatment Costs ◽  
Antibiotic Prescribing ◽  
North West ◽  
Manchester Triage System ◽  
Care Models ◽  
The Impact

BackgroundNon-urgent emergency department (ED) attendances are common among children. Primary care management may not only be more clinically appropriate, but may also improve patient experience and be more cost-effective.AimTo determine the impact on admissions, waiting times, antibiotic prescribing, and treatment costs of integrating a GP into a paediatric ED.Design and settingRetrospective cohort study explored non-urgent ED presentations in a paediatric ED in north-west England.MethodFrom 1 October 2015 to 30 September 2017, a GP was situated in the ED from 2.00 pm until 10.00 pm, 7 days a week. All children triaged as ‘green’ using the Manchester Triage System (non-urgent) were considered to be ‘GP appropriate’. In cases of GP non-availability, children considered non-urgent were managed by ED staff. Clinical and operational outcomes, as well as the healthcare costs of children managed by GPs and ED staff across the same timeframe over a 2-year period were compared.ResultsOf 115 000 children attending the ED over the study period, a complete set of data were available for 13 099 categorised as ‘GP appropriate’; of these, 8404 (64.2%) were managed by GPs and 4695 (35.8%) by ED staff. Median duration of ED stay was 39 min (interquartile range [IQR] 16–108 min) in the GP group and 165 min (IQR 104–222 min) in the ED group (P<0.001). Children in the GP group were less likely to be admitted as inpatients (odds ratio [OR] 0.16; 95% confidence interval [CI] = 0.13 to 0.20) and less likely to wait >4 hours before being admitted or discharged (OR 0.11; 95% CI = 0.08 to 0.13), but were more likely to receive antibiotics (OR 1.42; 95% CI = 1.27 to 1.58). Treatment costs were 18.4% lower in the group managed by the GP (P<0.0001).ConclusionGiven the rising demand for children’s emergency services, GP in ED care models may improve the management of non-urgent ED presentations. However, further research that incorporates causative study designs is required.

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