Staggered work shifts: a way to downsize and restructure an emergency department workforce yet maintain current operational performance.

Starting from the last decade of the twentieth century, most hospital Emergency Department (ED) budgets did not keep up with the demand for ED services made by growing populations and aging societies. Since labor consumes over 50% of the total monies invested in EDs and other healthcare systems, any downsizing, streamlining and reorganization plan needs to first address staffing issues such as determining the correct size of the workforce and its work shift scheduling. In this context, it is very important to remember that downsizing certainly does not mean a general cut-across-the-board. This study shows that a selective downsizing process in which each resource is treated separately (increasing the work capacity of some resources is also possible), based on its unique contribution to the overall ED operational performance, can approximately maintain current ED operational measures in terms patient length of stay (LOS) despite an overall reduction in staff hours. A linear optimization model (S-model) and a heuristic iterative simulation based algorithm (SWSSA) are used in this study for scheduling the resources' work shifts, one resource at a time. The algorithm was tested using data that was gathered from five general hospital EDs. By leveling the workload of the different resources in the ED, SWSSA was able to achieve LOS values within -19 to 4% of the original values despite a reduction of 8-17.5% in physicians' work hours and a reduction of 13-47% in the nurses' work hours.

Ways to reduce patient turnaround time and improve service quality in emergency departments.

PURPOSE: Recent years have witnessed a fundamental change in the function of emergency departments (EDs). The emphasis of the ED shifts from triage to saving the lives of shock-trauma rooms equipped with state-of-the-art equipment. At the same time walk-in clinics are being set up to treat ambulatory type patients. Simultaneously ED overcrowding has become a common sight in many large urban hospitals. This paper recognises that in order to provide quality treatment to all these patient types, ED process operations have to be flexible and efficient. The paper aims to examine one major benchmark for measuring service quality--patient turnaround time, claiming that in order to provide the quality treatment to which EDs aspire, this time needs to be reduced. DESIGN/METHODOLOGY/APPROACH: This study starts by separating the process each patient type goes through when treated at the ED into unique components. Next, using a simple model, the impact each of these components has on the total patient turnaround time is determined. This in turn, identifies the components that need to be addressed if patient turnaround time is to be streamlined. FINDINGS: The model was tested using data that were gathered through a comprehensive time study in six major hospitals. The analysis reveals that waiting time comprises 51-63 per cent of total patient turnaround time in the ED. Its major components are: time away for an x-ray examination; waiting time for the first physician's examination; and waiting time for blood work. ORIGINALITY/VALUE: The study covers several hospitals and analyses over 20,000 process components; as such the common findings may serve as guidelines to other hospitals when addressing this issue.