•Read the scenario and questions for Exercise 14.7.

 

14.7 Scenario-

 

Emergency room use at SAVE ME!! Hospital peaks on Saturday nights during the period from 7:00p.m to 2.00 am. Historically, the hospital has provided space for five stations (examining rooms) for nonemergency cases and two stations for emergency cases during that period. Nonemergency patients are examined on a first-come, first served basis, and emergency cases are treated on a most-serious, first-served basis, after a triage nurse has screened all cases. An area competitor hospital recently announced discontinuation of emergency services within six months. SAVE ME!!! estimates that current arrivals patterns during the 7:00pm – 2:00am period would increase by one-third for nonemergency cases and would double for emergency cases. The hospital wants to know how additional resources in the ER might reduce congestion and waiting time, as well as the overall cost of operations for nonemergency and for the emergency patients.

 

The past years operating data were gathered from the information system; they included records of arrival and service times. Preliminary examination of the data revealed little seasonal variation in ER use for that year, and ER personnel stated that their protocols and procedures had remained relatively constant since the reorganization of the ER two years ago.

 

The arrival pattern of patients, tabulated for twenty Saturday nights (total of one hundred hours) showed that 900 nonemergency and 150 emergency patients came to the ER during that time. The arrival pattern approximates a Poisson distribution. After a lengthy time- motion study, the average service time was found to be thirty minutes per nonemergency and seventy-five minutes per emergency patient. A separate study conducted by the fiancé/accounting department provided estimates for relevant costs as shown in Table EX 14.7

 

Cost type/Patient type	Nonemergency	Emergency
Busy server cost/hr	100	200
Idle server cost/hr	450	800
Customer waiting cost/hr	200	400
Customer being served cost/hr	100	300

 

A.Using the Excel queuing template, analyze both the emergency and the nonemergency capacity requirements for current conditions and for six months later, and fill in the performanceEvaluation Table.

 

 

 

 

 

 

 

•Download the Forecast for SAVE-ME Hospital ED spreadsheet, which provides the numerical solutions to Exercise 14.7.

 

 

 

•Take some time to examine and interpret this spreadsheet. Note that it provides a forecast for emergency and non-emergency cases arriving at this ED for 6 months in the future. Identify results that are significant in terms of capacity management issues.

 

 

 

•Review the Hospital-Based Emergency Care excerpt (pages 1–4), from this week’s required resources, regarding key challenges in EDs. Refer also to the forecasted data provided in the 14.7 solution spreadsheet. Based on this information, and doing further research as needed, identify some operational issues that would need to be addressed so that this ED is able to meet capacity demands in 6 months.

 

Summary (Hospital- Based Emergency Care 1-4)

 

Hospital-based emergency and trauma care is critically important to the health and well-being of Americans. In 2003, nearly 114 million visits were made to hospital emergency departments (EDs)—more than one for every three people in the United States. About one-quarter of those visits were due to unintentional injuries, the leading cause of death for people aged 1 through 44. While most Americans encounter the ED only rarely, they count on it to be there when they need it.

 

Over the last several decades, the role of hospital-based emergency and trauma care has evolved. EDs continue to focus on their traditional mission of providing urgent and lifesaving care, but have taken on additional responsibilities to meet the needs of communities, providers, and patients. Today, their complex role also encompasses safety net care for uninsured patients, public health surveillance, disaster preparedness, and serving as an adjunct to community physician practices. In some rural communities, the hospital ED may be the main source of health care for a widely dispersed population. While the demands on emergency and trauma care have grown dramatically, however, the capacity of the system has not kept pace. Balancing these roles in the face of increasing patient volume and limited resources has become increasingly challenging. The situation is creating a widening gap between the quality of emergency care Americans expect and the quality they actually receive.

 

 

 

STUDY CHARGE

 

The Institute of Medicine’s (IOM) Committee on the Future of Emergency Care in the United States Health System was formed in September

 

 

 

Response/Answer to the following:

 

•Select and interpret some significant results in this spreadsheet. What do the numbers you selected mean in operational terms?

 

 

 

 

 

•What are one or two specific operational issues that the manager of this ED would need to address in light of these 6-month forecasts, either for the emergency or non-emergency cases? Discuss the implications for the manager and staff of these anticipated changes in capacity requirement