QP - Using Queueing Theory to Increase the Effectiveness of...

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1 Using Queueing Theory to Increase the Effectiveness of ED Provider Staffing Objectives: Significant variation in emergency department (ED) patient arrival rates necessitates the adjustment of staffing patterns to optimize the timely care of patients . This study evaluates the effectiveness of a queueing model in identifying provider staffing patterns to reduce the fraction of patients who leave without being seen (LWBS). Methods: We collected detailed emergency department arrival data from an urban hospital and used a “Lag SIPP” queueing analysis to gain insights on how to change provider staffing to decrease the proportion of patients who leave without being seen. We then compared this proportion for the same 39 week period before and after the resulting changes. Results: Despite an increase in arrival volume of 1078 patients (6.3%), an average increase in provider hours of 12 hours/week (3.1%) resulted in 258 fewer patients who left without being seen. This represents a decrease in the proportion of patients who left without being seen by 22.9%. Restricting attention to a 4 day subset of the week during which there was no increase in total provider hours, a reallocation of providers based on the queueing model resulted in 161 fewer patients who left without being seen (21.7%) despite an additional 548 patients (5.5%) arriving in the second half of the study. Conclusion: Timely access to a provider is a critical dimension of emergency department quality performance. In an environment in which emergency departments 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. INTRODUCTION Several national reports have documented a growing demand for care from emergency departments (EDs) and a simultaneous decrease in the number of operating emergency departments. The result has been increased crowding, prolonged waiting times to be treated by an emergency provider (i.e. physician or physician assistant), and high percentages of patients leaving emergency departments without being seen.[1, 2] A recent study found that in 2001, 7.7% of the 36.6 million adults in the U.S. who sought care in a hospital emergency department reported trouble in receiving emergency care, and that over half of these cited long waiting times as a cause.[3] Timely access to an emergency provider is a critical dimension of quality for emergency departments. Yet, hospitals often struggle to provide adequate staffing to handle increasing demands for care. Constrained provider capacity relative to demand volume is exacerbated by the extreme variability in demand during each 24 hour period experienced by a typical emergency department. This time-of-day pattern, as reported in the National Hospital Ambulatory Medical Care Survey for 2002 is distinguished by a relatively low level of demand during the night followed by a precipitous increase starting at about 8 or 9 A.M., a peak at about noon, and persistently high levels until late
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2 evening. [4]
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