ABSTRACT
PURPOSE: The purpose of this article is to find decision-making models for the design and control of processes regarding patient flows, considering various problem types, and to find out how usable these models are for managerial decision making. DESIGN/METHODOLOGY/APPROACH: A systematic review of the literature was carried out. Relevant literature from three databases was selected based on inclusion and exclusion criteria and the results were analyzed. FINDINGS: A total of 68 articles were selected. Of these, 31 contained computer simulation models, ten contained descriptive models, and 27 contained analytical models. The review showed that descriptive models are only applied to process design problems, and that analytical and computer simulation models are applied to all types of problems to approximately the same extent. Only a few models have been validated in practice, and it seems that most models are not used for their intended purpose: to support management in decision making. RESEARCH LIMITATIONS/IMPLICATIONS: The comparability of the relevant databases appears to be limited and there is an insufficient number of suitable keywords and MeSH headings, which makes searching systematically within the broad field of health care management relatively hard to accomplish. PRACTICAL IMPLICATIONS: The findings give managers insight into the characteristics of various types of decision-support models and into the kinds of situations in which they are used. ORIGINALITY/VALUE: This is the first time literature on various kinds of models for supporting managerial decision making in hospitals has been systematically collected and assessed.
Subject(s)
Decision Support Techniques , Hospital Administration , Quality Assurance, Health Care/methods , Systems Analysis , Humans , Outcome and Process Assessment, Health Care/methodsABSTRACT
OBJECTIVE: To investigate whether 'advanced triage' improved patient flow among self-referred patients in the emergency department of a level 1 trauma centre and, most importantly, whether the quality of medical care was maintained. In advanced triage, the triage nurse initiates additional diagnostic investigations independently. DESIGN: Interventional study. METHODS: After a baseline measurement had been carried out for eleven days (n = 506), the advanced triage protocol was tested during ten day or evening shifts (n = 198). The length of stay in the emergency department was measured. The attending emergency physician assessed the correctness and completeness of the additional diagnostics initiated by the triage nurse. Two traumatologists and two radiologists assessed the quality of x-ray imaging requests independently of each other. RESULTS: Average patient length of stay (LOS) was reduced by fourteen minutes (14%). The improvement was achieved primarily in patients who required additional diagnostic investigations. Their average LOS decreased by 27 minutes (18%). There was an 8% increase in the total number of diagnostic investigations requested. The triage nurse initiated the investigations correctly and fully in 93% of cases. The quality of x-ray imaging requests remained the same as before the introduction of advanced triage. CONCLUSION: The implementation of advanced triage improved patient flow for self-referred patients in the emergency department without affecting the quality of medical care. Advanced triage was successful in the Dutch system, too.
