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Patient Streaming as a Mechanism for Improving Responsiveness in Emergency Departments

Author

Listed:
  • Soroush Saghafian

    (Industrial Engineering, School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, Arizona 85281)

  • Wallace J. Hopp

    (Ross School of Business, University of Michigan, Ann Arbor, Michigan 48109)

  • Mark P. Van Oyen

    (Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan 48109)

  • Jeffrey S. Desmond

    (Emergency Department, University of Michigan Hospital, Ann Arbor, Michigan 48109)

  • Steven L. Kronick

    (Emergency Department, University of Michigan Hospital, Ann Arbor, Michigan 48109)

Abstract

Crisis-level overcrowding conditions in emergency departments (EDs) have led hospitals to seek out new patient-flow designs to improve both responsiveness and safety. One approach that has attracted attention and experimentation in the emergency medicine community is a system in which ED beds and care teams are segregated and patients are “streamed” based on predictions of whether they will be discharged or admitted to the hospital. In this paper, we use a combination of analytic and simulation models to determine whether such a streaming policy can improve ED performance, where it is most likely to be effective, and how it should be implemented for maximum performance. Our results suggest that the concept of streaming can indeed improve patient flow, but only in some situations. First, ED resources must be shared across streams rather than physically separated. This leads us to propose a new “virtual-streaming” patient flow design for EDs. Second, this type of streaming is most effective in EDs with (1) a high percentage of admitted patients, (2) longer care times for admitted patients than discharged patients, (3) a high day-to-day variation in the percentage of admitted patients, (4) long patient boarding times (e.g., caused by hospital “bed-block”), and (5) high average physician utilization. Finally, to take full advantage of streaming, physicians assigned to admit patients should prioritize upstream (new) patients, whereas physicians assigned to discharge patients should prioritize downstream (old) patients.

Suggested Citation

  • Soroush Saghafian & Wallace J. Hopp & Mark P. Van Oyen & Jeffrey S. Desmond & Steven L. Kronick, 2012. "Patient Streaming as a Mechanism for Improving Responsiveness in Emergency Departments," Operations Research, INFORMS, vol. 60(5), pages 1080-1097, October.
    • Handle: RePEc:inm:oropre:v:60:y:2012:i:5:p:1080-1097
    DOI: 10.1287/opre.1120.1096
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    References listed on IDEAS

    as
    1. Wallace J. Hopp & Seyed M. R. Iravani & Biying Shou, 2005. "Serial Agile Production Systems with Automation," Operations Research, INFORMS, vol. 53(5), pages 852-866, October.
    2. Eylem Tekin & Wallace Hopp & Mark Van Oyen, 2009. "Pooling strategies for call center agent cross-training," IISE Transactions, Taylor & Francis Journals, vol. 41(6), pages 546-561.
    3. Bin Hu & Saif Benjaafar, 2009. "Partitioning of Servers in Queueing Systems During Rush Hour," Manufacturing & Service Operations Management, INFORMS, vol. 11(3), pages 416-428, October.
    4. Michael H. Rothkopf & Paul Rech, 1987. "Perspectives on Queues: Combining Queues is Not Always Beneficial," Operations Research, INFORMS, vol. 35(6), pages 906-909, December.
    5. Nilay Tan{i}k Argon & Serhan Ziya, 2009. "Priority Assignment Under Imperfect Information on Customer Type Identities," Manufacturing & Service Operations Management, INFORMS, vol. 11(4), pages 674-693, June.
    6. Sigrún Andradóttir & Hayriye Ayhan & Douglas G. Down, 2003. "Dynamic Server Allocation for Queueing Networks with Flexible Servers," Operations Research, INFORMS, vol. 51(6), pages 952-968, December.
    7. Ward Whitt, 1999. "Partitioning Customers into Service Groups," Management Science, INFORMS, vol. 45(11), pages 1579-1592, November.
    8. Soroush Saghafian & Mark Van Oyen & Bora Kolfal, 2011. "The “W” network and the dynamic control of unreliable flexible servers," IISE Transactions, Taylor & Francis Journals, vol. 43(12), pages 893-907.
    9. Izak Duenyas & Diwakar Gupta & Tava Lennon Olsen, 1998. "Control of a Single-Server Tandem Queueing System with Setups," Operations Research, INFORMS, vol. 46(2), pages 218-230, April.
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