Process Management Model in the Emergency Department of a University Hospital: Reduction of Patient Waiting Times by Changes in Human Resources

Abstract

Aim and Background: Emergency Department (ED) manages medical, surgical emergencies and victims of accidents, as one of the most important departments of the hospital. The most common problem is the overcrowding and long patient waiting times, as factors of dissatisfaction for patients and associated relatives. The purpose of this study is to design a process management model of ED in the Al-Zahra Hospital, for reduction of congestion and patient waiting times. Materials and Methods: This descriptive and functional research was conducted as a retrospective cross-sectional study. The study population includes 39264 people, referred to the Al-Zahra Hospital. The sample size was estimated 1275 subjects, through systematic random sampling with a confidence level of 99, but in order to increase the validity of the research, the number of cases was increased to 2515. Data were collected, using a questionnaire and Hospital Information System (HIS). Statistical analysis was performed, using Excel software. The distribution function model was:-0.001 + EXPO (13.2), using the input Analyzer for detection. The three-point distribution was used for all process functions and 1000 runs were performed, using the ARENA software. Findings: Simulation of the existing situation showed that patients' bottlenecks were in the following stations: the first examination by a specialist and writing orders, executing physician's orders by a nurse, registering patient's trials on HIS, and performing Electrocardiogram (ECG). Thus, the 29 solutions to reduce the patient bottlenecks concerning waiting times have been proposed. Subsequently, scenarios were simulated and compared, using the Arena software. Conclusions: The comparison of solutions showed that the most favorable solution is the scenario No 19, decreasing the patient waiting time and stay time, as much as 9.542 and 6.563 percent, respectively. This scenario suggests that instead of having a nurse at each level, two personnel refer the patient to the ward and jointly work between the two levels.