PLANNING-MODEL OF RESOURCE UTILIZATION IN AN ACADEMIC PEDIATRIC EMERGENCY DEPARTMENT

This study describes a field observation study and use of simulation t o quantify the effect of patient arrival fate and physician practices on physician idle time and patient wait time, The observation study me asured actual service (diagnosis, therapy, and charting) times for 126 patients, Subsequently, a FORTRAN simulation model examined effects o f physician practices and patient arrival rate on physician utilizatio n and patient wait time, Observations were taken in the emergency depa rtment of an urban, university-affiliated pediatric teaching hospital, Although times for initial diagnostic evaluation (diagnosis), therapy , and charting averaged 13.3, 13.8, and 11.6 minutes, respectively, ma ximum patient visits approached six hours, The simulation model shored that, during times of frequent patient arrivals, maximum patient wait times increased greatly, Additionally, the model predicted that physi cian idle time persists even during periods of frequent patient arriva ls and long maximum visit times, Emergency department (ED) senior staf f (fellows and attendings) often begin treating new patients when curr ent patients leave for tests external to the ED, This practice increas es physician utilization and makes more physician capacity available, but it may lead to small additional patient waits if the physician is treating another patient when the first patient returns from the exter nal test before their original physician becomes free, On the other ha nd, during periods of high patient arrivals, increased physician utili zation and reduced idle time result in reduced average and expected ma ximum patient visit times, Unfortunately the variability in visit time s increased, A very small percentage of patients wait longer, owing to additional waits incurred upon returning from external testing, Overa ll, most patients benefit from shorter visits, Finally, the study sugg ested maximum rather than average wait time be considered as a measure of emergency department capacity and quality of service provided, Alt hough average wait times seemed reasonable, maximum wait times were at times quite long and could impact both physician's and patient's perc eptions of service quality.