Improving emergency department performance by revising the patient–physician assignment process

Lien Vanbrabant (), Kris Braekers () and Katrien Ramaekers ()
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Lien Vanbrabant: UHasselt
Kris Braekers: UHasselt
Katrien Ramaekers: UHasselt

Flexible Services and Manufacturing Journal, 2021, vol. 33, issue 3, No 7, 783-845

Abstract: Abstract Emergency departments (EDs) are continuously exploring opportunities to improve their efficiency. A new opportunity lies in revising the patient–physician assignment process by limiting the number of patients simultaneously assigned to a single physician, which is defined as the application of a case manager approach with limited caseloads. The potential of introducing a case manager approach with limited caseloads as a way to improve physician productivity, and consequently ED performance, is investigated by use of a discrete-event simulation model based on a real-life case study. In addition, as the case manager system is characterised by three parameters that can be customised and optimised (i.e. caseload limit, pre-assignment queueing discipline and internal queueing discipline), the impact of these parameters on the effectiveness to improve ED performance in terms of length-of-stay and door-to-doctor time is evaluated. To the best of our knowledge, this paper is the first to examine the potential of a case manager system with limited caseloads in a complex service system like a real-life ED, and to investigate the impact of the three system parameters on the results. The outcomes of the study show that performance can be improved significantly by introducing a case manager system, and that the system parameters have an impact on the effect size.

Keywords: Discrete-event simulation; Emergency department; Case managers; Real-life case study; Healthcare operations (search for similar items in EconPapers)
Date: 2021
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DOI: 10.1007/s10696-020-09388-2

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