Using Queueing Theory to Increase the Effectiveness of Emergency Department Provider Staffing

Green, Linda V.; Soares, João; Giglio, James; Green, Robert A.

doi:10.1111/j.1553-2712.2006.tb00985.x

Cited by 191 publications

(153 citation statements)

References 9 publications

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“…In accordance to the increase in size and complexity of these systems more sophisticated solution approaches were developed. For example, to take into account the clear linkage that exists between the staffing levels in consecutive periods Green et al [21] developed a lagged SIPP queuing model and used it to analyze different staffing schemes in an ED. Bard and Purnomo [4] introduce a multi-objective model for scheduling nurses that aims to determine the optimal tradeoff between scheduling internal nurses versus using 'floating' nurses who can be hired for short periods of time (weeks or even days).…”

Section: Literature Reviewmentioning

confidence: 99%

Staggered work shifts: a way to downsize and restructure an emergency department workforce yet maintain current operational performance

Sinreich

Jabali

2007

Health Care Manage Sci

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Starting from the last decade of the twentieth century, most hospital Emergency Department (ED) budgets did not keep up with the demand for ED services made by growing populations and aging societies. Since labor consumes over 50% of the total monies invested in EDs and other healthcare systems, any downsizing, streamlining and reorganization plan needs to first address staffing issues such as determining the correct size of the workforce and its work shift scheduling. In this context, it is very important to remember that downsizing certainly does not mean a general cut-across-the-board. This study shows that a selective downsizing process in which each resource is treated separately (increasing the work capacity of some resources is also possible), based on its unique contribution to the overall ED operational performance, can approximately maintain current ED operational measures in terms patient length of stay (LOS) despite an overall reduction in staff hours. A linear optimization model (S-model) and a heuristic iterative simulation based algorithm (SWSSA) are used in this study for scheduling the resources' work shifts, one resource at a time. The algorithm was tested using data that was gathered from five general hospital EDs. By leveling the workload of the different resources in the ED, SWSSA was able to achieve LOS values within -19 to 4% of the original values despite a reduction of 8-17.5% in physicians' work hours and a reduction of 13-47% in the nurses' work hours.

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Section: Literature Reviewmentioning

confidence: 99%

Staggered work shifts: a way to downsize and restructure an emergency department workforce yet maintain current operational performance

Sinreich

Jabali

2007

Health Care Manage Sci

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“…Classic early work includes the queueing based models developed by Young [16], Cooper and Corcoran [17], Shonick [18,19] and McClain [20]. More recently, the use of queueing models for bed sizing has been explored by Green et al [21][22][23], Gorunescu et al [24] and McManus et al [25]. One criticism commonly leveled at standard queueing models in the context of patient flow modeling is the reliance on exponential distributed length of stay distributions.…”

Section: Related Workmentioning

confidence: 99%

“…Equation 23 sets upper and lower bounds on the number of scheduled inductions and scheduled cesareans by time period of day and day of week. Equations 24 and 25 set upper and lower bounds on the number of scheduled inductions and scheduled cesareans by day of week and for the entire week, respectively.…”

Section: Model: Ob-smooth Minimizementioning

confidence: 99%

An open source software project for obstetrical procedure scheduling and occupancy analysis

Isken

Ward

Littig³

2010

Health Care Manag Sci

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Increases in the rate of births via cesarean section and induced labor have led to challenging scheduling and capacity planning problems for hospital inpatient obstetrical units. We present occupancy and patient scheduling models to help address these challenges. These patient flow models can be used to explore the relationship between procedure scheduling practices and the resulting occupancy on inpatient obstetrical units such as labor and delivery and postpartum. The models capture numerous important characteristics of inpatient obstetrical patient flow such as time of day and day of week dependent arrivals and length of stay, multiple patient types and clinical interventions, and multiple patient care units with inter-unit patient transfers. We have used these models in several projects at different hospitals involving design of procedure scheduling templates and analysis of inpatient obstetrical capacity. In the development of these models, we made heavy use of open source software tools and have released the entire project as a free and open source model and software toolkit.

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“…Altinel and Ulas [8] developed a SLAM-IIbased simulation model to propose an adequate bed capacity requirement plan for the Surgical Emergency Department of the Istanbul University School of Medicine. Green et al [9] constructed an M/M/s queuing model for a simplified ED process to identify provider staffing patterns and reduce the fraction of patients who leave without being seen. Cochran and Roche [10] derived an open queuing network model for an ED design that is intended to increase the capacity of an ED to treat patients.…”

Section: Literature Reviewmentioning

confidence: 99%

Stochastic resource allocation in emergency departments with a multi-objective simulation optimization algorithm

Feng

Chen

2015

Health Care Manag Sci

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The number of emergency cases or emergency room visits rapidly increases annually, thus leading to an imbalance in supply and demand and to the long-term overcrowding of hospital emergency departments (EDs). However, current solutions to increase medical resources and improve the handling of patient needs are either impractical or infeasible in the Taiwanese environment. Therefore, EDs must optimize resource allocation given limited medical resources to minimize the average length of stay of patients and medical resource waste costs. This study constructs a multi-objective mathematical model for medical resource allocation in EDs in accordance with emergency flow or procedure. The proposed mathematical model is complex and difficult to solve because its performance value is stochastic; furthermore, the model considers both objectives simultaneously. Thus, this study develops a multi-objective simulation optimization algorithm by integrating a non-dominated sorting genetic algorithm II (NSGA II) with multi-objective computing budget allocation (MOCBA) to address the challenges of multi-objective medical resource allocation. NSGA II is used to investigate plausible solutions for medical resource allocation, and MOCBA identifies effective sets of feasible Pareto (non-dominated) medical resource allocation solutions in addition to effectively allocating simulation or computation budgets. The discrete event simulation model of ED flow is inspired by a Taiwan hospital case and is constructed to estimate the expected performance values of each medical allocation solution as obtained through NSGA II. Finally, computational experiments are performed to verify the effectiveness and performance of the integrated NSGA II and MOCBA method, as well as to derive non-dominated medical resource allocation solutions from the algorithms.

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Using Queueing Theory to Increase the Effectiveness of Emergency Department Provider Staffing

Abstract: Timely access to a provider is a critical dimension of ED quality performance. In an environment in which EDs are often understaffed, analyses of arrival patterns and the use of queueing models can be extremely useful in identifying the most effective allocation of staff.

Cited by 191 publications

References 9 publications

Staggered work shifts: a way to downsize and restructure an emergency department workforce yet maintain current operational performance

Staggered work shifts: a way to downsize and restructure an emergency department workforce yet maintain current operational performance

An open source software project for obstetrical procedure scheduling and occupancy analysis

Stochastic resource allocation in emergency departments with a multi-objective simulation optimization algorithm

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