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Identifying Good Nursing Levels: A Queuing Approach

Author

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  • Natalia Yankovic

    (Columbia Business School, New York, New York 10025)

  • Linda V. Green

    (Columbia Business School, New York, New York 10025)

Abstract

Nursing care is arguably the single biggest factor in both the cost of hospital care and patient satisfaction. Inadequate inpatient nursing levels have also been cited as a significant factor in medical errors and emergency room overcrowding. Yet, there is widespread dissatisfaction with the current methods of determining nurse staffing levels, including the most common one of using minimum nurse-to-patient ratios. In this paper, we represent the nursing system as a variable finite-source queuing model. We develop a reliable, tractable, easily parameterized two-dimensional model to approximate the actual interdependent dynamics of bed occupancy levels and demands for nursing. We use this model to show how unit size, nursing intensity, occupancy levels, and unit length-of-stay affect the impact of nursing levels on performance and thus how inflexible nurse-to-patient ratios can lead to either understaffing or overstaffing. The model is also useful for estimating the impact of nurse staffing levels on emergency department overcrowding.

Suggested Citation

  • Natalia Yankovic & Linda V. Green, 2011. "Identifying Good Nursing Levels: A Queuing Approach," Operations Research, INFORMS, vol. 59(4), pages 942-955, August.
    • Handle: RePEc:inm:oropre:v:59:y:2011:i:4:p:942-955
    DOI: 10.1287/opre.1110.0943
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    References listed on IDEAS

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    1. Linda Green, 2006. "Queueing Analysis in Healthcare," International Series in Operations Research & Management Science, in: Randolph W. Hall (ed.), Patient Flow: Reducing Delay in Healthcare Delivery, chapter 0, pages 281-307, Springer.
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    Cited by:

    1. Carri W. Chan & Linda V. Green & Suparerk Lekwijit & Lijian Lu & Gabriel Escobar, 2019. "Assessing the Impact of Service Level When Customer Needs Are Uncertain: An Empirical Investigation of Hospital Step-Down Units," Management Science, INFORMS, vol. 65(2), pages 751-775, February.
    2. Carri W. Chan & Vivek F. Farias & Nicholas Bambos & Gabriel J. Escobar, 2012. "Optimizing Intensive Care Unit Discharge Decisions with Patient Readmissions," Operations Research, INFORMS, vol. 60(6), pages 1323-1341, December.
    3. Hideaki Takagi & Yuta Kanai & Kazuo Misue, 2017. "Queueing network model for obstetric patient flow in a hospital," Health Care Management Science, Springer, vol. 20(3), pages 433-451, September.
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    5. Yuta Kanai & Hideaki Takagi, 2021. "Markov chain analysis for the neonatal inpatient flow in a hospital," Health Care Management Science, Springer, vol. 24(1), pages 92-116, March.
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    8. Fernanda Campello & Armann Ingolfsson & Robert A. Shumsky, 2017. "Queueing Models of Case Managers," Management Science, INFORMS, vol. 63(3), pages 882-900, March.
    9. Chen, Wanying (Amanda) & De Koster, René B.M. & Gong, Yeming, 2021. "Performance evaluation of automated medicine delivery systems," Transportation Research Part E: Logistics and Transportation Review, Elsevier, vol. 147(C).
    10. Malaki, Saha & Izady, Navid & de Menezes, Lilian M., 2023. "A framework for optimal recruitment of temporary and permanent healthcare workers in highly uncertain environments," European Journal of Operational Research, Elsevier, vol. 308(2), pages 768-781.
    11. Linda V. Green & Sergei Savin & Nicos Savva, 2013. "“Nursevendor Problem”: Personnel Staffing in the Presence of Endogenous Absenteeism," Management Science, INFORMS, vol. 59(10), pages 2237-2256, October.
    12. Jingui Xie & Weifen Zhuang & Marcus Ang & Mabel C. Chou & Li Luo & David D. Yao, 2021. "Analytics for Hospital Resource Planning—Two Case Studies," Production and Operations Management, Production and Operations Management Society, vol. 30(6), pages 1863-1885, June.
    13. Carmen, Raïsa & Van Nieuwenhuyse, Inneke & Van Houdt, Benny, 2018. "Inpatient boarding in emergency departments: Impact on patient delays and system capacity," European Journal of Operational Research, Elsevier, vol. 271(3), pages 953-967.
    14. Wu, Xiaodan & Li, Juan & Chu, Chao-Hsien, 2019. "Modeling multi-stage healthcare systems with service interactions under blocking for bed allocation," European Journal of Operational Research, Elsevier, vol. 278(3), pages 927-941.
    15. David D. Cho & Kurt M. Bretthauer & Jan Schoenfelder, 2023. "Patient-to-nurse ratios: Balancing quality, nurse turnover, and cost," Health Care Management Science, Springer, vol. 26(4), pages 807-826, December.
    16. Ingolfsson, Armann & Almehdawe, Eman & Pedram, Ali & Tran, Monica, 2020. "Comparison of fluid approximations for service systems with state-dependent service rates and return probabilities," European Journal of Operational Research, Elsevier, vol. 283(2), pages 562-575.
    17. Fernanda Campello & Armann Ingolfsson & Robert A. Shumsky, 2018. "Queueing Models of Case Managers," Management Science, INFORMS, vol. 64(1), pages 7-26, January.
    18. Mohammad Heydari & Kin Keung Lai & Yanan Fan & Xiaoyang Li, 2022. "A Review of Emergency and Disaster Management in the Process of Healthcare Operation Management for Improving Hospital Surgical Intake Capacity," Mathematics, MDPI, vol. 10(15), pages 1-34, August.
    19. Navid Izady & Israa Mohamed, 2021. "A Clustered Overflow Configuration of Inpatient Beds in Hospitals," Manufacturing & Service Operations Management, INFORMS, vol. 23(1), pages 139-154, 1-2.
    20. Pengyi Shi & Mabel C. Chou & J. G. Dai & Ding Ding & Joe Sim, 2016. "Models and Insights for Hospital Inpatient Operations: Time-Dependent ED Boarding Time," Management Science, INFORMS, vol. 62(1), pages 1-28, January.
    21. Masoud Kamalahmadi & Kurt M. Bretthauer & Jonathan E. Helm & Alex F. Mills & Edwin C. Coe & Alisa Judy-Malcolm & Areeba Kara & Julian Pan, 2023. "Mixing It Up: Operational Impact of Hospitalist Caseload and Case-Mix," Management Science, INFORMS, vol. 69(1), pages 283-307, January.
    22. Yue Zhang & Martin L. Puterman & Matthew Nelson & Derek Atkins, 2012. "A Simulation Optimization Approach to Long-Term Care Capacity Planning," Operations Research, INFORMS, vol. 60(2), pages 249-261, April.
    23. Carri W. Chan & Galit Yom-Tov & Gabriel Escobar, 2014. "When to Use Speedup: An Examination of Service Systems with Returns," Operations Research, INFORMS, vol. 62(2), pages 462-482, April.
    24. Carri W. Chan & Vivek F. Farias & Gabriel J. Escobar, 2017. "The Impact of Delays on Service Times in the Intensive Care Unit," Management Science, INFORMS, vol. 63(7), pages 2049-2072, July.
    25. Kauhanen, Antti & Kulvik, Martti & Kulvik, Silja & Maijanen, Sirpa & Martikainen, Olli & Ranta, Paula, 2013. "Resource allocation in health care processes: A case study," ETLA Working Papers 10, The Research Institute of the Finnish Economy.

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