Patient Streaming as a Mechanism for Improving Responsiveness in Emergency Departments

Operations Research, 2012, 60(5), 1080-1097

Ross School of Business Paper No. 1162

58 Pages Posted: 19 Aug 2011 Last revised: 29 May 2015

See all articles by Soroush Saghafian

Soroush Saghafian

Harvard University - Harvard Kennedy School (HKS)

Wallace J. Hopp

University of Michigan, Stephen M. Ross School of Business

Mark P. Van Oyen

University of Michigan at Ann Arbor

Jeffrey S. Desmond

University of Michigan Hospitals

Steven L. Kronick

University of Michigan Hospitals

Date Written: March 2012

Abstract

Crisis level overcrowding conditions in Emergency Departments (ED's) 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 ED's. Second, this type of streaming is most effective in ED's 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, while physicians assigned to discharge patients should prioritize downstream (old) patients..

Keywords: Health Care Operations Management, Emergency Department, Patient Flow, Patient Sequencing

JEL Classification: C44, L89, I18

Suggested Citation

Saghafian, Soroush and Hopp, Wallace J. and Van Oyen, Mark P. and Desmond, Jeffrey S. and Kronick, Steven L., Patient Streaming as a Mechanism for Improving Responsiveness in Emergency Departments (March 2012). Operations Research, 2012, 60(5), 1080-1097, Ross School of Business Paper No. 1162, Available at SSRN: https://ssrn.com/abstract=1911856 or http://dx.doi.org/10.2139/ssrn.1911856

Soroush Saghafian (Contact Author)

Harvard University - Harvard Kennedy School (HKS) ( email )

79 John F. Kennedy Street
Cambridge, MA 02138
United States

Wallace J. Hopp

University of Michigan, Stephen M. Ross School of Business ( email )

701 Tappan Street
Ann Arbor, MI MI 48109
United States

Mark P. Van Oyen

University of Michigan at Ann Arbor ( email )

500 S. State Street
Ann Arbor, MI 48109
United States

Jeffrey S. Desmond

University of Michigan Hospitals ( email )

1500 E. Medical Center Drive
Ann Arbor, MI 48109
United States

Steven L. Kronick

University of Michigan Hospitals ( email )

1500 E. Medical Center Drive
Ann Arbor, MI 48109
United States

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