Question

Problem 4 (16 points)

Consider a typical patient's stay in the emergency department (ED). On average, 10 patients arrive to the ED per hour.

Triage: Once a patient arrives, he/she is first triaged at the triage station which is staffed with one triage nurse. The triage process takes 5 minutes on average.

Initial Consultation: After triage, the patient goes through initial consultation with a nurse who takes information on the patient's demographics, medical history, allergies, etc. On average, initial consultation takes 22 minutes, and there is a total of 3 nurses exclusively dedicated to this process.

CT Scan: To simplify the analysis, it is assumed that all patients are sent to take a CT scan. The CT scan takes on average 20 minutes, with a total of 3 machines available.

Blood Test: After the CT scan, all patients move on to have a blood test. The CT scan takes on average 30 minutes, with a total of 4 independent medical staff designated at the blood test center.

Treatment with Physician: After triage, initial consultation, CT scan, and blood test, patients see a physician and receive treatment. On average, a physician spends 40 minutes with a patient, during which the physician diagnoses the patient and performs relevant medical procedures in order. There is a total of 6 physicians in the ED at any given time.

Observation: After seeing the physician, patients need to be observed for two hours and a half in the ED. During observation, patients are attended to by observation nurses in the ED, who frequently check on the patients to assist with unfinished medical procedures and track the patients' recovery. In total, 13 observation nurses are staffed in the ED at any given time. After observation, the patients leave the ED without further delay.

1. (4 points) Draw a process flow diagram for the ED and complete the following table for the patient flow information at each station.

	Triage	Initial Consultation	CT Scan	Blood Test	Treatment with Physician	Observation
Activity time (min)
Number of workers
Capacity (patients/hour)
Process capacity (patients/hour)
Demand rate (patients/hour)
Flow rate (patients/hour)
Utilization

2. (4 points) What is the bottleneck in the ED? Explain (Short answer.)

3. (4 points) What is the cycle time in the ED? Explain briefly the difference between cycle time and throughput time.

4. (4 points) Hospital management wants to increase the staffing level sequentially (one a at time) to bring up the process capacity. Determine the station(s) and the number of additional staff needed at the station(s) you identify in order to increase the process capacity by 2 patients per hour. You should report the minimum number of additional staff needed.

Answer 1

#. Bottleneck in the ED - a bottleneck is a special kind of constraint that relates to the capacity shortage of a process, and is defined as any resource whose available capacity limits the organization's ability to meet the service. Here it's the shortage of resources , staff in the emergency department which is affecting the efficiency of the emergency services .

#. Cycle time in ED is the total time of waiting plus throughoutput time ( which includes - procedure time , inspection time etc )

Throughput Time = Process Time + Inspection Time + Move Time + Queue Time

Delivery Cycle Time

Delivery Cycle Time = Wait Time + Throughput Time

#. To improve the emergency services we must have sufficient staff to provide care . The number of staffs to be increased at every station are :-

Triage - 3 staffs

Initial consultation - 5 staffs

Blood test - 6 staffs

Physician - 8 staffs

Observation nurse - 15 staffs