Patient Assignment Models in the Emergency Department

Hodgson, Nicole R.; Traub, Stephen J.

doi:10.1016/j.emc.2020.03.003

Cited by 8 publications

(6 citation statements)

References 34 publications

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“…A more recent paper by Hodgson and Traub [ 46 ] deals with diverse variations of patient assignment systems, including provider-in-triage/team triage, fast-tracks/vertical pathways, and rotational patient assignment. The authors discussed the theory behind such system variations and reviewed potential benefits of specific models of patient assignment found in the current literature.…”

Section: Practical Approaches To Managing Ed Queueingmentioning

confidence: 99%

Queueing Problems in Emergency Departments: A Review of Practical Approaches and Research Methodologies

Elalouf

Wachtel

2021

Oper. Res. Forum

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Problems related to patient scheduling and queueing in emergency departments are gaining increasing attention in theory, in the fields of operations research and emergency and healthcare services, and in practice. This paper aims to provide an extensive review of studies addressing queueing-related problems explicitly related to emergency departments. We have reviewed 229 articles and books spanning seven decades and have sought to organize the information they contain in a manner that is accessible and useful to researchers seeking to gain knowledge on specific aspects of such problems. We begin by presenting a historical overview of applications of queueing theory to healthcare-related problems. We subsequently elaborate on managerial approaches used to enhance efficiency in emergency departments. These approaches include bed management, fast-track, dynamic resource allocation, grouping/prioritization of patients, and triage approaches. Finally, we discuss scientific methodologies used to analyze and optimize these approaches: algorithms, priority models, queueing models, simulation, and statistical approaches.

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Section: Practical Approaches To Managing Ed Queueingmentioning

confidence: 99%

Queueing Problems in Emergency Departments: A Review of Practical Approaches and Research Methodologies

Elalouf

Wachtel

2021

Oper. Res. Forum

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“…A multitude of strategies have been proposed and attempted to help promote ED flow, each targeted at several distinct stages of patient care 1,2 . One proposed strategy has been the use of a “vertical” or “split‐flow” care model—broad terms used to define patients who may be evaluated without the use of a bed, hence remaining “vertical.” 4 These care models target mid‐acuity patients, typically those identified by the Emergency Severity Index (ESI) as a level 3 patient. Split flow or vertical models have been proposed as cost‐effective and efficient strategies to improve patient flow when employed properly 5 .…”

Section: Introductionmentioning

confidence: 99%

Overcoming stagnant flow: A scoping review of vertical movement in the emergency department

Lowie,

Hicks,

Falat

et al. 2024

Academic Emergency Medicine

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PurposeImproving emergency department (ED) patient flow has plagued many hospitals worldwide. “Vertical” flow improves throughput by maximizing use of chairs and waiting areas instead of beds. This process, however, is inconsistently described in the literature. The objective of this study is to collate existing evidence of successful vertical care programs.MethodA scoping review was conducted within several databases utilizing key search terms to capture relevant traditional and gray literature. All articles were uploaded into Covidence (n = 1000). After removal of duplicates, remaining abstracts were initially screened by two reviewers (n = 731). Records identified by at least one reviewer subsequently underwent a two‐reviewer full text screening for inclusion (n = 46). This process yielded 36 articles. Finally, each record underwent data extraction by two independent study members and any inconsistencies were resolved by a third study member. Extracted data included 21 predetermined variables. Descriptive statistics were used to summarize results.ResultsOf the 36 included articles, most were published from the United States (91.7%), after 2014 (55.6%), and as a peer‐reviewed article or abstract/conference proceeding (86.1%). While every article discussed some aspect of "vertical" flow, most (77.8%) were observational studies. Only half of the studies reported details of staffing and/or physical resources. A variety of challenges and success strategies were described, with several themes identified. Positive outcomes were reported by most articles (86%), although measurement of outcomes varied with the two most common being length of stay (69.4%) and arrival to provider time (55.6%).ConclusionsThe findings of this scoping review provide the first summative report of existing literature on vertical flow processes within the ED setting. Despite different measurable outcomes and varied processes, most articles support the use of vertical flow to improve throughput.

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“…Nevertheless, empirical medical research reports that performance improvements are obtained when using a dedicated queueing system based on simple rotational patient assignment (SRPA) [10][11][12][13][14][15][16][17] as opposed to a single queue configuration. Reported improvements include a reduction in arrivalto-provider time (APT), 11,13,14,16,17 an increase in patient satisfaction, 11,12 and improvements in length of stay (LOS), 4,16,17 discharge rates, 14 left-before-being-seen, 16,17 and complaint ratios.…”

Section: Introductionmentioning

confidence: 99%

Acuity-based rotational patient-to-physician assignment in an emergency department using electronic health records in triage

Cildoz

Ibarra²,

Giménez

2023

Health Informatics J

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Emergency department (ED) operational metrics generated by a new acuity-based rotational patient-to-physician assignment (ARPA) algorithm are compared with those obtained with a simple rotational patient assignment (SRPA) system aimed only at an equitable patient distribution. The new ARPA method theoretically guarantees that no two physicians’ assigned patient loads can differ by more than one, either partially (by acuity levels) or in total; whereas SRPA guarantees only the latter. The performance of the ARPA method was assessed in practice in the ED of the main public hospital (Hospital Compound of Navarra) in the region of Navarre in Spain. This ED attends over 140 000 patients every year. Data analysis was conducted on 9,063 ED patients in the SRPA cohort, and 8,892 ED patients in the ARPA cohort. The metrics of interest are related both to patient access to healthcare and physician workload distribution: patient length of stay; arrival-to-provider time; ratio of patients exceeding the APT target threshold; and range of assigned patients across physicians by priority levels. The transition from SRPA to ARPA is associated with improvements in all ED operational metrics. This research demonstrates that ARPA is a simple and useful strategy for redesigning front-end ED processes.

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Patient Assignment Models in the Emergency Department

Cited by 8 publications

References 34 publications

Queueing Problems in Emergency Departments: A Review of Practical Approaches and Research Methodologies

Queueing Problems in Emergency Departments: A Review of Practical Approaches and Research Methodologies

Overcoming stagnant flow: A scoping review of vertical movement in the emergency department

Acuity-based rotational patient-to-physician assignment in an emergency department using electronic health records in triage

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