Acuity-based rotational patient-to-physician assignment in an emergency department using electronic health records in triage

Emergency department (ED) operational metrics generated by a new acuity-based rotational patient-to-physician assignment (ARPA) algorithm are compared with those obtained with a simple rotational patient assignment (SRPA) system aimed only at an equitable patient distribution. The new ARPA method theoretically guarantees that no two physicians' assigned patient loads can differ by more than one, either partially (by acuity levels) or in total; whereas SRPA guarantees only the latter. The performance of the ARPA method was assessed in practice in the ED of the main public hospital (Hospital Compound of Navarra) in the region of Navarre in Spain. This ED attends over 140 000 patients every year. Data analysis was conducted on 9,063 ED patients in the SRPA cohort, and 8,892 ED patients in the ARPA cohort. The metrics of interest are related both to patient access to healthcare and physician workload distribution: patient length of stay; arrival-to-provider time; ratio of patients exceeding the APT target threshold; and range of assigned patients across physicians by priority levels. The transition from SRPA to ARPA is associated with improvements in all ED operational metrics. This research demonstrates that ARPA is a simple and useful strategy for redesigning front-end ED processes.

Exploring the spatial arrangement of patient rooms for minimum nurse travel in hospital nursing units in Korea

With increasing demands on medical care services, one of the trends is the mixed patient room arrangement of single/double-bed and multi-bed rooms in a nursing unit on the same floor. This influences nurse-to-patient assignment and often causes an unbalanced workload and longer travel distances for nurses. The objective of this study was to investigate how floor configuration and room density influence nurse travel in the hospital's medical surgical units in Korea. This study presented a novel approach to measure nurse travel distances in eight existing nursing units. The agent-based simulation was conducted to model nurses' walking trails, and the distance of one nurse travel to assigned patient rooms was measured for each nurse. With revisions in the spatial arrangement of patient rooms, locating multi-bed rooms near the nurse station, symmetric room layout centering the nurse station, and planning both single/double-bed and multi-bed rooms on one side of corridors, nurse travel distance decreased more than 15%. This study contributed to the knowledge of agent-based simulation as an evaluation framework for spatial analysis. Apart from application to Korea, these results are particularly of interest in countries where private patient rooms are not commonly economically feasible.