An alternative scheduling approach for improving patient-flow in emergency departments

Publication date: Available online 28 August 2015 Source:Operations Research for Health Care Author(s): Amir Elalouf, Guy Wachtel Overcrowding in hospitals, along with long lengths of stay, high arrival rates, budget constraints, and increasing demand for high service quality, create challenges for the work-flow and patient flow of hospital emergency departments (EDs). This paper proposes an algorithmic approach that seeks to enable ED decision makers (specifically, in the triage) to optimally schedule evaluations for patients who are waiting for treatment in the ED. The algorithm is an expansion of Karp’s job sequencing with deadlines problem Karp (1972) and is embedded in a simulation model. From a managerial perspective, overcrowding can cause substantial profit loss to the ED and the other departments. We assume that, in order to prevent this profit loss, the hospital management determines a maximal (fixed or dynamic) value for patients’ length of stay and for crowding levels in the various departments, and that patients who cannot be evaluated in the ED in a timely fashion are redirected for treatment in other hospital departments. The latter approach (referred to as the ”floating patient” method) is practiced, for example, in Israel. To build the algorithm, we solve this problem gradually; first we solve a scenario in which the triage decision maker has full information on patients’ conditions and on how long their ED-treatments are expected to take. W...
Source: Operations Research for Health Care - Category: Hospital Management Source Type: research