Vertical Patient Streaming in Emergency Departments

Tackling hospital emergency department (ED) overcrowding is a paramount challenge for healthcare systems. To combat this issue, an innovative approach is to identify patients who can be served vertically (i.e., in a seated position) and route them to a dedicated area termed the Vertical Processing Pathway (VPP). Successfully implementing this design requires understanding which patients should be routed to the VPP and when. Currently, the decision to leverage the VPP is made in an ad-hoc fashion. To assist our partner hospital and other EDs in capturing the value of the VPP, we develop a machine learning model that provides personalized risk scores predicting whether each arriving patient will need an ED bed. We use these scores as input to a stochastic patient flow model and analytically characterize the optimal VPP policy that minimizes length of stay. Employing simulation analyses, we identify settings in which our proposed VPP design is preferable in terms of operational performance to traditional ED flow approaches, such as “fast track” or “physician in triage.” Finally, we derive an interpretable VPP patient streaming protocol and conduct a before-and-after experiment where we leverage empirical analyses to evaluate the impact of integrating it in practice. The implemented protocol led to an 11-minute (4.2%) reduction in ED length of stay without any adverse effect on quality-of-care outcomes. This effect was statistically significant and remained robust after controlling for confounding factors and endogeneity. Our work results in a VPP protocol generalizable to other EDs, offering operational improvements without requiring additional resources.

• 저널Management Science
• 토픽Healthcare Systems and Technology · Organizational Behavior and Human Resource Management
• DOI10.1287/mnsc.2024.07517
• 저자Arshya Feizi, Agni Orfanoudaki, Soroush Saghafian