Developing emergency department physician shift schedules optimized to meet patient demand

Abstract

Objectives: 1) To assess temporal patterns in historical patient arrival rates in an emergency department (ED) to determine the appropriate number of shift schedules in an acute care area and a fast-track clinic and 2) to determine whether physician scheduling can be improved by aligning physician productivity with patient arrivals using an optimization planning model. Methods: Historical data were statistically analyzed to determine whether the number of patients arriving at the ED varied by weekday, weekend, or holiday weekend. Poisson-based generalized additive models were used to develop models of patient arrival rate throughout the day. A mathematical programming model was used to produce an optimal ED shift schedule for the estimated patient arrival rates. We compared the current physician schedule to three other scheduling scenarios: 1) a revised schedule produced by the planning model, 2) the revised schedule with an additional acute care physician, and 3) the revised schedule with an additional fast-track clinic physician. Results: Statistical modelling found that patient arrival rates were different for acute care versus fast-track clinics; the patterns in arrivals followed essentially the same daily pattern in the acute care area; and arrival patterns differed on weekdays versus weekends in the fast-track clinic. The planning model reduced the unmet patient demand (i.e., the average number of patients arriving at the ED beyond the average physician productivity) by 19%, 39%, and 69% for the three scenarios examined. Conclusions: The planning model improved the shift schedules by aligning physician productivity with patient arrivals at the ED.

Studying the variability in patient inflow and staffing trends on Sundays versus other days in the academic emergency department

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Overuse of Health Care in the Emergency Services in Chile

“… Patients have limited Access to the PHC [ 42 ] due to the lack of available medical appointments in the short term. Emergency attention offers more convenient attention hours [ 43 ], including weekends [ 37 ], and provides immediate solution to the patient’s medical condition. In the primary care the anomaly situations must be searched for, which allows the detection of the pathology in a timely manner and thus, to achieve a correct referral to the Emergency Services for those patients who require other types of care, if necessary.…”

Patient Flow Analysis in General Hospitals: How Clinical Disciplines Affect Outpatient Wait Times

“…18 Results of studies have indicated that PFA was useful in controlling patient wait times and throughput in the system. 19,20 They also showed that PFA was successful in increasing the rate of accepted patients in a defined period by decreasing repeated visits to clinics. PFA was described as a simple and cost-effective method in assessing the function of outpatient facilities.…”