Monday Syndrome: Using Statistical and Mathematical Models to Fine-Tune Services in an Emergency Department

Цой, Л М; Ip, Sy; Poon, LK

doi:10.1177/102490791101800304

Cited by 5 publications

(4 citation statements)

References 11 publications

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“…In particular, the Monday to Tuesday overnight shift had the highest percentage of instances in which visit length of stay year to year was greater than the 70th or 90th percentile (Figure 4). Mondays are often the busiest day in the ED, 1,35 and our data confirm the increasingly outsized role the Monday overnight team bears in handling harder-than-expected loads year to year and that anticipated daily patient arrivals as a scheduling metric have not appropriately accounted for length-of-stay burden.…”

Section: Discussionsupporting

confidence: 62%

The Effect of Operational Stressors on Emergency Department Clinician Scheduling and Patient Throughput

Pines

Zocchi

Maio

et al. 2020

Annals of Emergency Medicine

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We assess the effect of emergency department (ED) operational stressors on clinician scheduling and throughput.Methods: We evaluated 2014 to 2018 data from a national ED group. Operational stressors included measures of workload, patient acuity, and complexity. We used multilevel linear regression to estimate the effect of operational stressors, temporal factors, and facility characteristics on ED clinician scheduling; patient throughput, measured as shift-level patient departures per corrected clinician hour; and length of stay.Results: In greater than 14 million ED visits across 359 facility-years, the mean of patient departures per corrected clinician hour was 2.23 (95% confidence interval [CI] 2.15 to 2.31). Temporal and facility effects had the greatest influence on patient departures per hour (eg, -0.55 [95% CI -0.75 to -0.36] in 7 AM to 3 PM shifts versus midnight to 7 AM on Mondays, 0.25 [95% CI 0.03 to 0.47]) in teaching versus nonteaching hospitals, and 0.43 (95% CI 0.24 to 0.61) in larger EDs (30,000 to 59,999 ED visits/year) versus smaller EDs. Operational stressors had significant but small effects on patient departures per hour (eg, length of stay [per-minute increase] 0.002 [95% CI 0.0019 to 0.0023] and percentage admitted [per 1% increase] -0.003 [95% CI -0.004 to -0.001]). Weekday nights, particularly Mondays, had the highest proportion of shifts with increasing length of stay compared with previous years in the same ED. Conclusion:ED operational stressors had minimal influence on patient throughput when included in adjusted ED clinician scheduling models, whereas temporal and facility factors were more influential. Therefore, incorporating operational stressors into ED clinician scheduling is less likely to balance workloads than accounting for temporal and facility-level factors alone. Length of stay on some shifts, particularly Monday nights, became increasingly long, suggesting they require additional resources. [

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Section: Discussionsupporting

confidence: 62%

The Effect of Operational Stressors on Emergency Department Clinician Scheduling and Patient Throughput

Pines

Zocchi

Maio

et al. 2020

Annals of Emergency Medicine

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“…By far, the result of the weekday patient volume that was highest during Mondays was consistent with various studies (11,13,14,17). A phenomenon known as "Monday syndrome" has been mentioned in several literature to loosely mean as an increase in demand of healthcare services during Mondays, causing reallocation of resources to accommodate the uneven clinical load during this day of the week (18). Monday also has been the busiest day of the week at the UP-PGH ED with the highest consultation and admission census.…”

Section: Discussionmentioning

confidence: 99%

“…Although Fridays have a comparable number of visits as Mondays, this was however not statistically correlated. Numerous reasons have been mentioned for the "Monday syndrome" which was perceived to be multifactorial (18) : occupational disease, workaholic breakdown, injury-related and general practitioners sending more patients to the ED after their weekend rest. In the local context, this can also be due to the return of Filipinos from weekend breaks when they usually defer going to the ED.…”

Section: Discussionmentioning

confidence: 99%

Determination of emergency department patient utilization and staffing at the University of the Philippines-Philippine General Hospital (UP-PGH)

Tabuñar,

Pagkatipunan

2023

FEM

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Objective: In developing staffing plans for emergency departments (EDs), a multifaceted approach must be considered without compromising quality of care, patient safety and personnel satisfaction. This study aims to determine the temporal trend of patient attendance and staffing in a major tertiary hospital ED to assist in establishing an optimal staffing pattern. Methods: A 1-year retrospective ED census review of adult patients at the University of the Philippines-Philippine General Hospital (UP-PGH) was undertaken. One-way analysis of variance (ANOVA) with post hoc Fisher-Hayter pairwise comparisons were utilized to determine if the ED consults and admissions were significantly (P<0.05) associated with the month of the year and day of the week. Results: A total 43,632 consults at the UP-PGH ED, averaging of 3,636 per month or 121 per day, were seen in 2019. Results indicated statistically significant differences between monthly [F (11,353) =16.45; P<0.0001] and between daily means [F (6,358) =4.19; P=0.0004]. The most number of consults occur during August, September, October and November while admissions were highest during April and October. It was busiest during Mondays and afternoon shifts (1400-2200 hours) with majority arriving as urgent in acuity. Mortality was also highest during the afternoon shifts. Conclusion: The temporal variations in patient visits and acuity described in our study can be used as a template for workforce scheduling and resource allocation to meet the demands in the provision of care at the ED.

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“…The first weekday is notable in terms of hospital congestion and wait time. Tosi et al found that the patients who are admitted the emergency department on Mondays were 12.2%, which is higher than the other days 32 . There is a need for a detailed research on both patients' and health workers' behaviors specific to Monday.…”

Section: Analysis Of Wait Times By Working Hours In Tertiary Level Ho...mentioning

confidence: 92%

Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week

Özen,

Köse,

Yıgıt

et al. 2024

Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi

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The time spent waiting is an important problem regarding patient satisfaction and hospital efficiency, and increases the need for evidence-based information for management to make decisions towards a solution. This study aims to examine the process flows in hospitals based on actual data with the intent to design a better service delivery system and set a pattern in terms of determining the congestion in the process and planning the necessary improvements. For this purpose, the data sets for 2016 pertaining to secondary and tertiary level hospitals in Turkey, which are stored in the central physician appointment system (CPAS), are investigated. The data is analyzed through pre-processing, cleaning and transformation stages. Congestion patterns are determined by days and hours spent in hospitals. Monday is found to be the day with the highest patient density and the longest wait time in Turkish hospitals. Additionally, when analyzed by working hours, it is determined that the first 2 hours in the morning (9.00 a.m. to 11.00 a.m.) is the period when most patentse are examined. The lunchtime (between 12.00 p.m. - 1.00 p.m.) and the afternoon from 4.00 p.m. to 5.00 p.m. are the times when patient density is the lowest, but average wait time is the longest. Turkish hospitals are found to be particularly congested on some days and during some hours regarding patient wait times. Thus, policy recommendations can be developed specifically to the days and times when congestion patterns are identified rather than suggesting a general policy. This study is the most comprehensive study conducted in Turkey through process data. The working model is reproducible in different countries and regions.

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Monday Syndrome: Using Statistical and Mathematical Models to Fine-Tune Services in an Emergency Department

Cited by 5 publications

References 11 publications

The Effect of Operational Stressors on Emergency Department Clinician Scheduling and Patient Throughput

The Effect of Operational Stressors on Emergency Department Clinician Scheduling and Patient Throughput

Determination of emergency department patient utilization and staffing at the University of the Philippines-Philippine General Hospital (UP-PGH)

Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week

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