Emergency departments (EDs) are continuously exploring opportunities to improve their efficiency. A new opportunity lies in revising the patient–physician assignment process by limiting the number of patients simultaneously assigned to a single physician, which is defined as the application of a case manager approach with limited caseloads. The potential of introducing a case manager approach with limited caseloads as a way to improve physician productivity, and consequently ED performance, is investigated by use of a discrete-event simulation model based on a real-life case study. In addition, as the case manager system is characterised by three parameters that can be customised and optimised (i.e. caseload limit, pre-assignment queueing discipline and internal queueing discipline), the impact of these parameters on the effectiveness to improve ED performance in terms of length-of-stay and door-to-doctor time is evaluated. To the best of our knowledge, this paper is the first to examine the potential of a case manager system with limited caseloads in a complex service system like a real-life ED, and to investigate the impact of the three system parameters on the results. The outcomes of the study show that performance can be improved significantly by introducing a case manager system, and that the system parameters have an impact on the effect size.
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Shortened as case manager approach in the remainder of this paper.
The technical report can be obtained from the corresponding author upon request or on the website https://www.uhasselt.be/Research-group-Logistics.
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This work is supported by the Strategic Basic Research project Data-driven logistics (S007318N), funded by the Research Foundation Flanders (FWO). This work is supported by the Special Research Fund (BOF) of Hasselt University (BOF20TT03).
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Appendix 1: Electronic health record data
Appendix 2: Validation
Appendix 3: Statistical analysis
This online appendix provides the results of Mauchly’s test of sphericity and the repeated-measures full factorial ANOVA. For all main effects and 2-way interactions in the ANOVA, the most appropriate F-statistic is determined by the results of Mauchly’s test of sphericity Tables 9 and 18. In case the results of Mauchly’s test provide evidence for the violation of the sphericity assumption at the 5% significance level (p value < 0.05), the G–G estimate of the F-statistic is used in the ANOVA. Otherwise, the sphericity assumed estimate of the F-statistic is used.
Scenario without multitasking effect
Scenario with multitasking effect
Appendix 4: Results scenario without multitasking effect
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Vanbrabant, L., Braekers, K. & Ramaekers, K. Improving emergency department performance by revising the patient–physician assignment process. Flex Serv Manuf J (2020). https://doi.org/10.1007/s10696-020-09388-2
- Discrete-event simulation
- Emergency department
- Case managers
- Real-life case study
- Healthcare operations