Abstract
To characterize the coupling effect between patient flow to access the emergency department (ED) and that to access the inpatient unit (IU), we develop a model with two connected queues: one upstream queue for the patient flow to access the ED and one downstream queue for the patient flow to access the IU. Building on this patient flow model, we employ queueing theory to estimate the average waiting time across patients. Using priority specific wait time targets, we further estimate the necessary number of ED and IU resources. Finally, we investigate how an alternative way of accessing ED (Fast Track) impacts the average waiting time of patients as well as the necessary number of ED/IU resources. This model as well as the analysis on patient flow can help the designer or manager of a hospital make decisions on the allocation of ED/IU resources in a hospital.
Highlights
Overcrowding in the emergency department (ED) is a worldwide problem [1,2,3] impairing the ability of hospitals to offer emergency care within a reasonable time frame [4].J
We develop a two-stream model to characterize the coupling effect between patient flow to access the ED and that to access the inpatient unit (IU)
Our model improves on previous research by taking into account both the reality of multiple priority classes competing for ED resources and the strong potential for downstream congestion impacting on the timely access of patients to the ED
Summary
The Canadian government published its own acuity guidelines in 1998, and subsequently revised them in 2004 and in 2008 In these guidelines, the severity of patients is classified into five levels: resuscitation, emergent, urgent, less urgent and non urgent [6]. As a means of addressing this issue, many hospitals have introduced a fast-track system for the lower (less urgent and non-urgent) priority patients on the premise that they can be served quickly and without tying up too many resources. This policy essentially means that a single queue is broken into two and the ones who inevitably suffer from such a policy are the patients at the end of the first queue (priority III patients).
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