Emergency Department Rotational Patient Assignment.

Area of Science:

• Emergency Medicine
• Healthcare Operations Management
• Systems Engineering

Background:

• Traditional physician self-assignment in emergency departments (EDs) can lead to inefficiencies.
• Optimizing patient flow and provider allocation is crucial for effective ED operations.

Purpose of the Study:

• To compare emergency department (ED) operational metrics before and after implementing a rotational patient assignment system.
• To evaluate the impact of algorithmic patient assignment versus physician self-assignment on key performance indicators.

Main Methods:

• A pre-post retrospective study design was employed at a single ED.
• Operational metrics including length of stay, arrival-to-provider time, and patient departure rates were analyzed for 23,514 visits under self-assignment and 24,112 visits under rotational assignment.

Main Results:

• Rotational patient assignment led to significant improvements: median length of stay decreased by 11% (232 to 207 minutes), and median arrival-to-provider time improved by 44% (39 to 22 minutes).
• Rates of patients leaving before being seen decreased by 51% (0.73% to 0.36%), and the complaint ratio dropped by 40% (9.0/1,000 to 5.4/1,000).
• No significant changes were observed in rates of patients leaving subsequent to being seen or early return visits.

Conclusions:

• Transitioning from physician self-assignment to rotational patient assignment resulted in broad improvements in ED operational metrics.
• Rotational patient assignment presents a viable strategy for enhancing emergency department front-end process redesign and efficiency.