Policies for physician allocation to triage and treatment in emergency departments. Issue 4 (2nd October 2019)

• Record Type: Journal Article
• Authors: Zayas-Caban, Gabriel; Xie, Jingui; Green, Linda V.; Lewis, Mark E.
• Is Part Of: IISE transactions on healthcare systems engineering. Volume 9:Issue 4(2019)
• Page Start: 342
• Page End: 356
• Publication Date: 2019-10-02
• Subjects: Abandonments -- ED triage and treatment process -- simulation -- tandem queue; Biomedical engineering -- Periodicals; Medical informatics -- Periodicals; Medical care -- Periodicals; 610.28
• DOI: 10.1080/24725579.2019.1620384
• Languages: English
• ISSNs: 2472-5579

Abstract

Abstract: In the emergency department (ED), low-acuity patients divert resources from more critical patients. To facilitate flow, EDs are experimenting with new care models, such as the Triage-Treat-and-Release program at the Lutheran Medical Center (LMC) ED in New York, where physicians handle both phases of service for low-acuity patients. Our goal is to determine how physicians should prioritize triage versus treatment to balance initial delays with timely discharges. Triage and treatment are modeled as a two-phase stochastic service system, where patients may leave without receiving treatment. Patients leaving without receiving treatment increases the importance of the second phase. We introduce K -level threshold policies which prioritize treatment unless there are K or more patients in triage. The effect is a class of policies that capture a decision-maker's valuation of the importance of each activity; lower K values signifies triage priority. Sufficient conditions are provided to ensure these policies yield a stable system. A heuristic is presented for choosing K . Using LMC data, K -level threshold policies, compared to other practical policies, perform well with respect to average rewards and waiting times over a range of parameters. These policies promise physicians an effective and simple way to allocate their time between triage and treatment.