Patient Streaming as a Mechanism for Improving Responsiveness in Emergency Departments

Soroush Saghafian (), Wallace J. Hopp (), Mark P. Van Oyen (), Jeffrey S. Desmond () and Steven L. Kronick ()
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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

Operations Research, 2012, vol. 60, issue 5, 1080-1097

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.

Keywords: healthcare operations management; emergency department; patient flow; patient sequencing (search for similar items in EconPapers)
Date: 2012
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Citations: View citations in EconPapers (36)

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