Needy Boarding Patients in Emergency Departments: Defining a Control Policy for the Physicians

Abstract

Boarding patients and the extra workload they introduce are a major concern in emergency departments. Not in the least because they confront the physicians with a challenging task: prioritizing between boarding patients and patients currently under treatment in the emergency department. The main contribution of this paper is the examination of different control policies for the physicians when needy boarding patients are added to the analysis. Using discrete-event simulation, three static control policies (first-come, first-served and always prioritizing either boarding patients or the other patients) and two dynamic control policies (using threshold values and accumulating priorities) are studied. For operational system performance, the recommended control policy is simple and straightforward: never prioritize boarding patients. However, in an emergency department setting, health-related performance measures also need to be considered: physicians cannot disadvantage one type of patients in favour of operational system performance. The result is a trade-off between operational system performance measures and health-related performance measures. Furthermore, we conclude that applying a first-come, first-served policy performs extremely well in a wide range of situations.