Chapter 7 – Mini-case (pp. 253-255)
A local low-acuity emergency department wants to improve its patient flow. The facility has as its goal that 85 percent or more of the arriving patients will be seen by a doctor in 60 min or less. Currently, the facility is not meeting that goal. An initial, high-level process map has been developed, along with some observations from an outside team of analysts. Your task is to determine what else may be done to help this facility better understand the reasons it has been unable to meet its service-level goal. Specifically explain in detail how each of the eight approaches listed might help this facility in determining where it should focus its change efforts if it wants to meet its current service-level goal.
FIGURE 7.5 Process Flow at Low-Acuity Emergency Department Emergency Room Patient to Room Patient Arrives Patient to Triage Acuity 1 Acuity 2–5 Waiting Room Discharge Registration Triage Station Examination Room Observations 1. Time spent at registration is consistently less than five minutes. 2. Time spent in triage is consistently less than five minutes. 3. Time spent in the waiting room is highly variable (five minutes to 100 minutes) and depends on the patient’s acuity (more severe patients are seen more quickly). 4. Time spent in exam room is highly variable (10 minutes to 100 minutes) and depends on availability of doctor and extent of testing required. 5. Time spent at discharge is consistently less than five minutes. 6. The facility operates 15 hours a day, seven days a week. 7. The facility has 10 patient exam rooms, two full-time doctors, one part-time doctor, two nurses, and one triage nurse. 8. All patient diagnoses must be entered into a computer system by the doctor at the conclusion of a patient’s exam. Approaches to Consider • Process mapping (for subprocesses). • Value stream mapp Staffing and workload management Productivity analysis. Analysis of data for key emergency department productivity measures.
Chapter 8 – Q8 (pp. 285-286)
Use Solver to find the optimal solution to the given integer programming problem. Consider the same operating room discussed in the Solver example in the chapter. Suppose that instead of maximizing profit from surgeries, our objec- tive is to minimize the cost incurred due to surgeries. As before, we denote the number of major surgeries scheduled in a week using decision variable s1, the number of minor surgeries scheduled in a week using decision variable s2, and the number of elective surgeries scheduled in a week using decision variable s3.The relevant data for each type of surgery is: In addition, for this problem we will assume the facility has only one operating room, which is available 60 hours per week, and the facility has a total of 500 labor hours a week that can be devoted to surgeries. Prior to using Solver, you may want to formulate your problem (i.e., clearly identify decision variables, objective function, and constraints).