Queueing Theory In Hospital Management

14 million Canadians visit Emergency Departments (ED) every year, and also reported to having the highest use of EDs (Ontario Hospital Association, 2006). ED overcrowding in Canada has become an epidemic. ED overcrowding has been defined as “a situation in which the demand for emergency services exceeds the ability of an (emergency) department to provide quality care within acceptable time frames” (Ontario Ministry of Health and Long Term Care, 2014). This has been an ongoing problem across Canada. Ontario has developed an initiative to reduce ED wait times by implementing a variety of strategies and collaborating with other institutions. This paper describes the Emergency Room National Ambulatory Intuitive (ERNI), an

When overcrowding occurs, patients are placed in the hallway waiting for room to be transferred to. Any time overcrowding occurs most ambulances divert away from the closest hospital to the patients and in this situation hospitals lose a lot of revenue. Data published in the US Department of Health and Human Services (HHS) in 2004 report national hospital ambulatory medical care survey on ED summary depicted that ED in United State are approaching a boiling point in terms of increasing patient demand and shrinking bed capacity, Levin et al (Fall,2006). According to the Institute of Healthcare Improvement, a recent survey conducted by the American College of Emergency physician of about 200 hospital administrators, majority pointed at overcrowding as their major constraint and about 60% said overcrowding in their facility forces the diversion of patients with urgent need

St. Vincent’s Medical Center, a 501 bed facility located in Jacksonville, Florida, provides general medical and surgical care to the North Florida Region. St. Vincent’s admits over 26,000 patients annually. The average occupancy rate is approximately 84% with the Emergency Department (ED) peeking at 100% for approximately 4-12 hours daily. The hospital is struggling with availability of bed space. This shortage of available beds creates a bottleneck in the ED on high census days. Bottlenecks are created in the ED when there is a shortage of inpatient beds to place admitted ED patients. Thus, patient flow, or throughput, is becoming more and more important.

Emergency departments are considered an important aspect of the health care system. For many years, wait times have been an area of concern for many Canadians and remain a significant issue. One of the major concerns within the Canadian health care system is the amount of time spent as waiting time in the healthcare services. Wait times are the length of time from when the patient is triaged and registered, to when the patient leaves from the emergency room (Affleck, Parks, Drummond, Rowe, & Ovens, 2013). Whether waiting for a doctor, waiting for prescription medication, or even waiting to get tested, the reasons for wait time in Canada are caused by many factors (Cole, Hopman, & Kawakami, 2011). This paper will seek to examine the factors contributing to longer wait times in the emergency department, examine the ways in which wait times impact society, and conclude by presenting possible solutions to reduce wait times.

Hospitals need to measure performance in key areas that affect patient flow and capacity, and identify the drivers of capacity constraints and key opportunities for performance improvement.2 “Identifying real drivers of capacity constraints and key opportunities for performance improvement can be achieved by: Monitoring how many cases are being diverted from the hospital, understanding how systems and tools are functioning for patient admission, discharge, and transfer, determining the efficiency of activities such as bed tracking and control, patient transportation, housekeeping, and care delivery.3”

Queuing is feature of our daily life, whether in an airport, a post office or Emergency Departments(ED), few of us wishes to wait too long for service. The clinical cost of waiting too long for urgent treatment in an ED is all too long for service. Following media headlines, pooled with powerful political agenda lead to, in the late 1990s and the early 2000s many ED in the UK were struggling with high demand and poor patient flow. During this period it

(CITE) Despite its success the Canadian health care system has some concerns associated with it and It is important for policy makers, and the health management sector to address these issues and provide solutions for them. Health management is a complex social goal, and a major initiative in Canada, which is heavily relied on the public sector. One of the major issues the health care system is currently facing the over crowded emergency departments and extremely long waiting times. . In this paper I will discuss the issue of overcrowded hospitals as a results of the rising population of the elderly. Many of our hospitals are over crowned, there are long waiting time, and the elderly are not provided with sufficient care. Overcrowding will place an increasing amount of burden on the hospital by delaying testing and diagnosis times, creating a shortage of nurses and doctors, and it may also have a negative impact on the financial state of the hospital.

Lengthy time wait can result in an individual becoming more sick, due to the lack of attention they are receiving. In the province of Alberta, a women says “her life is wasting away after a series of miss communication.” Its been almost 10 years, and she still hasn’t received her treatment. As a country viewed as one of the best countries in terms of healthcare, the government fails to provide the citizens with proper care. However, analyzing Canadian wait time from a decade ago to the present day, Canada is ranked number 11 on the lowest wait time according to First minister accord. Canada advance to the top of the ranking by improving on some steps, such as diagnosing problems fast. By diagnosing the problem first, health care worker are able to aid patients to get the best and most efficient health services. Also, the main foundation to a a shorter wait time is the a strong and cooperative staff. With a great staff that are communicating, its easier to get through many patients in a day. (https://secure.cihi.ca/free_products/HCIC2012-FullReport-ENweb.pdf) If majority of our taxes is contributing into healthcare, we should be provided with fast and efficient service. Another alteration with having a lengthy wait is it affects individual who are in need of a

And finally, by increasing funding for doctors, the waiting time in emergency rooms would decrease significantly by enabling the hospital to staff more doctors during the busy hours of the day. It would allow the hospital to staff additional doctors at night as well. These steps have been taken in some hospitals with great success. Hospitals have begun to communicate the expected wait times to their patients, one hospital even goes so far as to post waiting room times on the internet in real time, as of July 20 2007 at 19:31 the wait in the 5 hospitals listed ranged between 0 – 2 hr 40 minutes with the average being about

A point prevalence study conducted by … fount that the mean reported waiting time was 3.7 hours per patient. The times for the longest boarded patient ranged from 15 minutes to 33 hours, with a mean maximum waiting time of 8.3 hours. The prolonged ED waiting time resulted from ED overcrowding has negative adverse outcomes upon different stakeholders, including not only patients, but also staff members and hospitals.

This research is trying to answer the question of how to reduce overcrowding in emergency rooms? Would people would want to access published wait times provided on the internet, and would this guide a patient make decisions on where they receive their care. The hypothesis being one, crowding maybe reduced with having upfront information, and therefore also provide increased patient satisfaction due to waiting less. Patients would have more choices available to them such as

It is not easy to solve this problem, but somebody has to put their autrhoity on the table. One way to help with wait-times could be to work more organized. When we go to our local hospital there is just one emergency section, I think that there should be more emergency areas and each one should have different degree of urgency, even tough most hospitals have fast track areas to take care of non-urgent patients. So maybe the less severe in one area and the really crucial ones in another.

“Long wait times could potentially result in worse patient outcomes, greater patient suffering, patient dissatisfaction, more difficulty retaining and recruiting staff, a higher risk of infectious disease outbreaks and an increased risk of medical errors” (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 456). This article explored how the addition of nurse practitioners and physician assistants in 6 Ontario emergency departments could help to reduce wait time, patient flow, and the number of patients who left without being seen (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 455). This study was seen to be the first of its kind in analyzing effects in an emergency department on patient flow by adding nurse practitioners and physician assistants to the healthcare team (Ducharme, Alder, Pelletier, Murray, & Tepper, p. 459). The quantitative study design used for this study was the experimental design since it was based on implementation and evaluation of the effects (Keele, p. 41). The article does not address how the sample size was determined and actually

Providing the right care, to the right patient, at the right time is not only the definition of providing quality healthcare, but also the key to the long-run viability of our healthcare system. However, our hospital delivery system is often unable to match the supply of hospital services with the demand for that care. Intense, inherent demand variability renders this synchronization almost impossible to maintain for any significant period of time. The mismatch between patients and providers has been shown to lead to significant adverse effects: demand variability has been suggested as a main driver for increasing healthcare delivery costs (Litvak E and Buerhaus P, et al. 2005), unexpected surges in admission rates have been linked to increased

The aim of patient scheduling in hospitals is to allocate the limited and expensive resources of hospital to the patients. Optimization of patient scheduling allows hospitals to reduce costs and enables it to increase the utilization of capacity.