The Effects of Discrete Work Shifts on a Nonterminating Service System.

Area of Science:

• Healthcare Operations Research
• Emergency Medicine
• Queueing Theory

Background:

• Emergency departments (EDs) are typically modeled as nonterminating queues for continuous patient flow.
• Physician work in EDs occurs in discrete shifts, necessitating patient handoffs.
• The impact of physician shift changes on patient care processes and outcomes requires further investigation.

Purpose of the Study:

• To analyze how physician shift changes influence patient service completion rates in an academic medical center ED.
• To determine the effect of patient handoffs on expected treatment times and ED revisit rates.
• To explore strategies for mitigating patient handoffs and their consequences through simulation.

Main Methods:

• Analysis of patient data from a large, academic medical center ED.
• Statistical examination of service completion rates relative to physician shift timing.
• Simulation modeling to evaluate the impact of shift length and patient cutoff policies.

Main Results:

• Patient service completion rates vary significantly within physician shifts.
• Patients experiencing physician handoffs show a higher service completion rate but are more likely to revisit the ED within three days.
• Simulation indicates that reducing handoffs via shift length or cutoff rules can decrease system throughput.

Conclusions:

• Physician handoffs in EDs have a complex effect on patient treatment and revisit rates, suggesting a potential trade-off between process efficiency and clinical quality.
• ED operational strategies, such as shift scheduling and patient management policies, must consider the implications for patient outcomes.
• Further research is needed to optimize ED workflows to minimize adverse effects of patient handoffs while maintaining high patient throughput.