{"id":1696,"date":"2010-01-21T13:30:10","date_gmt":"2010-01-21T19:30:10","guid":{"rendered":"https:\/\/staging.opexlearning.com\/resources\/?p=1696"},"modified":"2019-12-01T00:07:19","modified_gmt":"2019-12-01T05:07:19","slug":"emergency-room-er-wait-times","status":"publish","type":"post","link":"https:\/\/staging.opexlearning.com\/resources\/emergency-room-er-wait-times\/1696\/","title":{"rendered":"Emergency Room (ER) Wait Times and Queueing Theory"},"content":{"rendered":"<div class=\"a296a24fa2fc69ef5487857f02f111e8\" data-index=\"9\" style=\"float: none; margin:10px 0 10px 0; text-align:center;\">\n<script async src=\"\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- Single Post readerboard -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:inline-block;width:728px;height:90px\"\r\n     data-ad-client=\"ca-pub-8207522353004717\"\r\n     data-ad-slot=\"1144967431\"><\/ins>\r\n<script>\r\n(adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" style=\"margin: 3px;\" title=\"er waiting room time\" src=\"https:\/\/staging.opexlearning.com\/resources\/wp-content\/gallery\/blog-pictures\/7-shmula-er-wait-time.jpg\" alt=\"emergency room, wait time, queueing theory, design thinking, shmula, ideo, ethnography, anthropology, lean manufacturing, lean thinking, six sigma, metacool, diego rodriquez\" width=\"303\" height=\"187\" align=\"right\" hspace=\"3\" vspace=\"3\" \/><a title=\"little's law can be used to determine wait times in emergency rooms\" href=\"https:\/\/staging.opexlearning.com\/resources\/littles-law\/8035\/\">ER Wait Times<\/a> and <a title=\"articles on queueing theory applications to business\" href=\"https:\/\/staging.opexlearning.com\/resources\/queueing-theory\/\">Queueing Theory<\/a> is an article exploring queueing and waiting times in healthcare.<\/p>\n<p>The Emergency Room plays a vital role in patient care and plays an important role in communities and society.\u00a0 According to the CDC, there were 119.2 million visits to the Emergency Room in 2007 <sup class='footnote'><a href='#fn-1696-1' id='fnref-1696-1' onclick='return fdfootnote_show(1696)'>1<\/a><\/sup>.\u00a0 Indeed, the demand for emergency room care is great.<\/p>\n<p>With the aging demographic, we can expect the demand for emergency care to only increase, compounding the already heavy burden on finite critical care resources.\u00a0 One outcome of this dynamic is that patients might have to wait longer in order to receive emergency care.<\/p>\n<p>This, of, course, is antithetical to the notion of &#8220;emergency care&#8221;, which implies that you need care now, not in 2 hours.\u00a0 One way healthcare professionals deal with this is through preventive care and education &#8211; there are some ailments that don&#8217;t need emergency care.\u00a0 Reducing the number of inbound ER patients can reduce the burden and free-up capacity for those more in need.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-4409\" title=\"1-shmula-er-wait-time\" src=\"https:\/\/staging.opexlearning.com\/resources\/wp-content\/uploads\/2010\/01\/1-shmula-er-wait-time-300x46.jpg\" alt=\"twitter waiting room emergency time\" width=\"300\" height=\"46\" srcset=\"https:\/\/staging.opexlearning.com\/resources\/wp-content\/uploads\/2010\/01\/1-shmula-er-wait-time-300x46.jpg 300w, https:\/\/staging.opexlearning.com\/resources\/wp-content\/uploads\/2010\/01\/1-shmula-er-wait-time.jpg 386w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/>Another approach is to manipulate the natural Queueing System and its properties.\u00a0 One important property of Queueing Systems is that they are &#8220;bursty&#8221; &#8211; that is, things happen almost all at the same time.\u00a0 This is the &#8220;rush hour&#8221; phenomenon.\u00a0 But, on other times, things are really slow.\u00a0 How can the ER level demand ac<img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-4410\" title=\"6-shmula-er-wait-time\" src=\"https:\/\/staging.opexlearning.com\/resources\/wp-content\/uploads\/2010\/01\/6-shmula-er-wait-time.jpg\" alt=\"wait time at hospital\" width=\"243\" height=\"566\" \/>ross busy and non-busy times?\u00a0 To answer that question, healthcare professionals are publishing their Emergency Room Wait Times.\u00a0 They do this for several reasons:<\/p>\n<ol>\n<li>Publishing ER Wait Times is a form of Visual Management coupled with public scrutiny.\u00a0 If ER Wait Times are high, then it allows the ER Staff to self-assess and adjust accordingly to bring that Wait Time down.\u00a0 In other words, increase capacity by either bringing in more MDs and RNs or just working faster.<\/li>\n<li>Publishing ER Wait Times can be a strategic marketing move.\u00a0 If one needs to go to an ER, most people would prefer to go to one where the Wait Time is lower.\u00a0 Providing Wait Time information can help the patient make a better decision.<\/li>\n<li>Publishing ER Wait Times is a way for hospitals to level-load across busy times and non-busy times.\u00a0 But, the level-load is at the discretion of the patient &#8211; whether they decide to go to the ER during a busy time, wait until the wait time is agreeable, or go to another hospital.\u00a0 Of course, sometimes patients don&#8217;t have a choice, especially when the emergency is truly life threatening.<\/li>\n<\/ol>\n<h2><span style=\"color: #800000;\">Door-to-Doc-to-Door: Emergency Room Process Steps<\/span><\/h2>\n<p>In general, the steps in an Emergency Room are the following:<\/p>\n<ol>\n<li>Patient Arrival<\/li>\n<li>Triage<\/li>\n<li>RN Assessment<\/li>\n<li>MD Assessment<\/li>\n<li>Initial Diagnosis and Treatment<\/li>\n<li>Diagnostic Testing<\/li>\n<li>Follow-up or Treatment Planning<\/li>\n<li>Discharge or Hospital Admit<\/li>\n<\/ol>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-4411\" title=\"5-shmula-er-wait-time\" src=\"https:\/\/staging.opexlearning.com\/resources\/wp-content\/uploads\/2010\/01\/5-shmula-er-wait-time.jpg\" alt=\"er wait time directory\" width=\"520\" height=\"316\" \/><\/p>\n<p>While there are roughly 8 steps, as most of us know, the ER experience isn&#8217;t as simple as I make it out to be.\u00a0 The service delivery steps can be quite complex and the needs of other patients can impact the service you are receiving.\u00a0 In other words, unpredictability is a big factor.\u00a0 That is not to say that there isn&#8217;t waste in the service delivery process &#8211; because there is &#8211; but the greater unknown is the emergency that is greater than yours, which will impact the service you are receiving.<\/p>\n<h2><span style=\"color: #800000;\">Emergency Room Statistics<\/span><\/h2>\n<p><span style=\"color: #800000;\"><span style=\"color: #000000;\">Before going into the mechanics of Queueing, let&#8217;s look at some historical data on Emergency Room visits:<\/span><br \/>\n<\/span><\/p>\n<ul>\n<li>Number of visits: 119.2 million<\/li>\n<li>Number of injury-related visits: 42.4 million<\/li>\n<li>Number of visits per 100 persons: 40.5<\/li>\n<li>Most commonly diagnosed condition: injury and poisoning<\/li>\n<li>Percent of visits with patient seen in fewer than 15 minutes: 22%<\/li>\n<li>Median time spent in emergency department: 2.6 hours<\/li>\n<li>Percent of visits resulting in hospital admission: 13%<\/li>\n<li>Percent of visits resulting in transfer to a different hospital: 1.9%<\/li>\n<\/ul>\n<h2><span style=\"color: #800000;\">On Emergency Room Queueing<\/span><\/h2>\n<p>Important queueing properties of a system are the following:<\/p>\n<ol>\n<li>\u00ce\u00bb = Arrival Rate, or more specific, the time between arrivals.\u00a0 For most queues, we can assume that the arrival distribution can be approximated by a Poisson distribution; which means that the time between arrivals are not deterministic, but random.\u00a0 More specific, the Mean and Standard Deviation are approximately the same.\u00a0 We experience this as &#8220;traffic congestion&#8221; or &#8220;lunch hour rush&#8221; &#8211; it happens all at the same time.<\/li>\n<li>\u00ce\u00bc = Service Rate, or the time it takes to service an arrival.\u00a0 This can also be called Cycle Time in other contexts.<\/li>\n<\/ol>\n<p>Here, we use a single-server model, which is a good approximation for most queues.\u00a0 Let us assume the following:<\/p>\n<ol>\n<li>\u00ce\u00bb = 50 patients \/ 8 hour day (480 minutes) = 6.25 patients arrive per hour on average<\/li>\n<li>\u00ce\u00bc = Assume that 12 patients are serviced per hour (in-and-out) on average<\/li>\n<\/ol>\n<p>The assumptions above give us the following:<\/p>\n<h2><span style=\"color: #800000;\">Occupancy, Traffic Intensity, Utilization<\/span><strong><span style=\"color: #800000;\"><br \/>\n<\/span><\/strong><\/h2>\n<blockquote><p>P = (\u00ce\u00bb \/ \u00ce\u00bc)<\/p><\/blockquote>\n<p>so,<\/p>\n<blockquote><p>P = (6.25 \/ 12) = 2.99 patients on average are served per hour<\/p><\/blockquote>\n<h2><span style=\"color: #800000;\">Door-to-Doc-to-Door: Total Time Spent in System<\/span><\/h2>\n<blockquote><p>T<sub>s<\/sub> = (1 \/ (\u00ce\u00bc  \u00ce\u00bb))<\/p><\/blockquote>\n<p>So,<\/p>\n<blockquote><p>T<sub>s<\/sub> = (1 \/ (12  6.25)) = .17 * 60 minutes = 10.43 minutes total time in system<\/p><\/blockquote>\n<p>Now, we know from experience that 10 minutes door-to-doc-to-door is not reality.\u00a0 I purposely made Average Service Rate greater than Average Arrival Rate, but in most cases that is not true.\u00a0 but we&#8217;re not too far off &#8211; CDC data tells us that 22% of ER cases were door-to-doc-to-door in under 15 minutes.<\/p>\n<h2><span style=\"color: #800000;\">Design Thinking and the Emergency Room<strong><br \/>\n<\/strong><\/span><\/h2>\n<p>Aside from the technical aspects of time and waste, there is a big opportunity for Design Thinking in making the experience from Door-to-Doc a more pleasant one.\u00a0 Design Thinking can be very powerful here.<\/p>\n<p><span style=\"color: #800000;\"><strong>Hospitals that Publish ER Wait Times<\/strong><\/span><\/p>\n<p>Below is a list of Hospitals that publish Emergency Room Wait Times.\u00a0 I&#8217;m sure I&#8217;ve missed many; if you know of one that I haven&#8217;t included below, please include it in the comments:<\/p>\n<ul>\n<li>Mountain Vista Medical Center<\/li>\n<li>Scottsdale Healthcare<\/li>\n<li><a title=\"lean, er wait time, shmula\" href=\"https:\/\/www.honorhealth.com\/\">Osborn ER<\/a><\/li>\n<li><a title=\"lean, shmula, er wait times\" href=\"http:\/\/www.jfkmc.com\/\">JFK Medical Center<\/a><\/li>\n<li><a title=\"lean, shmula, er wait times\" href=\"http:\/\/www.aventurahospital.com\/\">Aventura Health and Medical Center<\/a><\/li>\n<li><a title=\"lean, shmula, er wait times\" href=\"http:\/\/www.blakemedicalcenter.com\/\">Blake Medical Center<\/a><\/li>\n<li><a title=\"lean, shmula, er wait time\" href=\"http:\/\/www.brandonhospital.com\/\">Brandon Regional Hospital<\/a><\/li>\n<li><a title=\"lean, er wait time, shmula\" href=\"http:\/\/www.oakhillhospital.com\/\">Oak Hill Hospital<\/a><\/li>\n<li><a title=\"shmula, lean, er wait time\" href=\"http:\/\/www.englewoodcommhospital.com\/\">Englewood Community Hospital<\/a><\/li>\n<li><a title=\"shmula, lean, er wait time\" href=\"http:\/\/www.lawnwoodmed.com\/\">Lawnwood Regional Medical Center<\/a><\/li>\n<li><a title=\"shmula, lean, er wait times, six sigma\" href=\"http:\/\/www.nfrmc.com\/\">North Florida Regional Medical Center<\/a><\/li>\n<li><a title=\"lean, shmula, six sigma, er wait times\" href=\"http:\/\/www.ocalaregional.com\/\">Ocala Regional Medical Center<\/a><\/li>\n<li><a title=\"six sigma, er wait times, shmula, lean\" href=\"http:\/\/www.rmchealth.com\/\">Regional Medical Center at Bayonet Point<\/a><\/li>\n<li><a title=\"lean, six sigma, er wait times\" href=\"http:\/\/www.memorialhospitaljax.com\/\">Memorial Hospital of Jacksonville<\/a><\/li>\n<li><a title=\"six sigma, shmula, lean, er wait times\" href=\"http:\/\/www.osceolaregional.com\/\">Osceola Regional Medical Center<\/a><\/li>\n<li><a title=\"lean, shmula, er wait times\" href=\"http:\/\/www.lakecitymedical.com\/\">Lake City Medical Center<\/a><\/li>\n<li>Sun Coast Hospital<\/li>\n<li><a title=\"lean, shmula, six sigma, er wait times\" href=\"http:\/\/www.palmswesthospital.com\/\">Palms West Hospital<\/a><\/li>\n<li><a title=\"lean, six sigma, er wait times, shmula\" href=\"http:\/\/www.northwestmed.com\/\">Northwest Medical Center<\/a><\/li>\n<\/ul>\n<div class='footnotes' id='footnotes-1696'>\n<div class='footnotedivider'><\/div>\n<ol>\n<li id='fn-1696-1'> Source, CDC: http:\/\/is.gd\/6ISBJ <span class='footnotereverse'><a href='#fnref-1696-1'>&#8617;<\/a><\/span><\/li>\n<\/ol>\n<\/div>\n<!--CusAds0-->\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>ER Wait Times and Queueing Theory is an article exploring queueing and waiting times in healthcare. The Emergency Room plays a vital role in patient care and plays an important role in communities and society.\u00a0 According to the CDC, there were 119.2 million visits to the Emergency Room in 2007 1.\u00a0 Indeed, the demand for [&hellip;]<\/p>\n","protected":false},"author":12327,"featured_media":9553,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[654],"tags":[641,643,642,640],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>ER Wait Times and 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