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Facets of operational performance in an emergency room (ER)

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  • van der Vaart, Taco
  • Vastag, Gyula
  • Wijngaard, Jacob

Abstract

This paper, using detailed time measurements of patients complemented by interviews with hospital management and staff, examines three facets of an emergency room's (ER) operational performance: (1) effectiveness of the triage system in rationing patient treatment; (2) factors influencing ER's operational performance in general and the trade-offs in flow times, inventory levels (that is the number of patients waiting in the system), and resource utilization; (3) the impacts of potential process and staffing changes to improve the ER's performance. Specifically, the paper discusses four proposals for streamlining the patient flow: establishing designated tracks ("fast track," "diagnostic track"), creating a "holding" area for certain type of patients, introducing a protocol that would reduce the load on physicians by allowing a registered nurse to order testing and treatment for some patients, and potentially and in the longer term, moving from non-ER specialist physicians to ER specialists. The paper's findings are based on analyzing the paths and flow times of close to two thousand patients in the emergency room of the Medical Center of Leeuwarden (MCL), The Netherlands. Using exploratory data analysis the paper presents generalizable findings about the impacts of various factors on ER's lead-time performance and shows how the proposals fit with well-documented process improvement theories.

Suggested Citation

  • van der Vaart, Taco & Vastag, Gyula & Wijngaard, Jacob, 2011. "Facets of operational performance in an emergency room (ER)," International Journal of Production Economics, Elsevier, vol. 133(1), pages 201-211, September.
    • Handle: RePEc:eee:proeco:v:133:y:2011:i:1:p:201-211
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    References listed on IDEAS

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    1. Vastag, Gyula & Kerekes, Sandor & Rondinelli, Dennis A., 1996. "Evaluation of corporate environmental management approaches: A framework and application," International Journal of Production Economics, Elsevier, vol. 43(2-3), pages 193-211, June.
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    1. Araz, Ozgur M. & Olson, David & Ramirez-Nafarrate, Adrian, 2019. "Predictive analytics for hospital admissions from the emergency department using triage information," International Journal of Production Economics, Elsevier, vol. 208(C), pages 199-207.
    2. Lee, Seung-Yup & Chinnam, Ratna Babu & Dalkiran, Evrim & Krupp, Seth & Nauss, Michael, 2021. "Proactive coordination of inpatient bed management to reduce emergency department patient boarding," International Journal of Production Economics, Elsevier, vol. 231(C).
    3. Golmohammadi, Davood & Radnia, Naeimeh, 2016. "Prediction modeling and pattern recognition for patient readmission," International Journal of Production Economics, Elsevier, vol. 171(P1), pages 151-161.
    4. Stefanini, Alessandro & Aloini, Davide & Gloor, Peter & Pochiero, Federica, 2021. "Patient satisfaction in emergency department: Unveiling complex interactions by wearable sensors," Journal of Business Research, Elsevier, vol. 129(C), pages 600-611.
    5. Rezapour, Shabnam & Naderi, Nazanin & Morshedlou, Nazanin & Rezapourbehnagh, Shaghayegh, 2018. "Optimal deployment of emergency resources in sudden onset disasters," International Journal of Production Economics, Elsevier, vol. 204(C), pages 365-382.
    6. Golmohammadi, Davood, 2016. "Predicting hospital admissions to reduce emergency department boarding," International Journal of Production Economics, Elsevier, vol. 182(C), pages 535-544.
    7. Colla, Marcos & Santos, Gilson Ditzel & Oliveira, Gilson Adamczuk & de Vasconcelos, Renata Braga Berenguer, 2023. "Ambulance response time in a Brazilian emergency medical service," Socio-Economic Planning Sciences, Elsevier, vol. 85(C).
    8. Dobrzykowski, David & Saboori Deilami, Vafa & Hong, Paul & Kim, Seung-Chul, 2014. "A structured analysis of operations and supply chain management research in healthcare (1982–2011)," International Journal of Production Economics, Elsevier, vol. 147(PB), pages 514-530.
    9. Benevento, Elisabetta & Aloini, Davide & Squicciarini, Nunzia, 2023. "Towards a real-time prediction of waiting times in emergency departments: A comparative analysis of machine learning techniques," International Journal of Forecasting, Elsevier, vol. 39(1), pages 192-208.

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