Abstract Emergency departments (EDs) across the world are experiencing severe crowding and prolonged patient wait times for hospital admissions (a.k.a. patient “boarding”). Using data from a major healthcare system, we show that EDs suffer from severe boarding not only due to a high level of hospital inpatient bed occupancy but also due to reactive coordination of inpatient bed management activities. To reduce patient boarding, we explore early task initiation for the service network spanning the ED and inpatient units within a hospital. In particular, we investigate the value of predicting ED patient admissions (to be specific, disposition decisions) during the ED caregiving process to proactively initiate downstream tasks for reduced patient boarding. We show that the coordination mechanism can be modeled as a fork–join queueing system. The proposed modeling framework accounts for both imperfect patient disposition predictions and multiple hospital admission sources (in addition to the ED) for inpatient units. We maintain analytical tractability while preserving the complexities of real-world inpatient bed management operations by characterizing the state sets and transition sequences through the Markovian assumption. The proactive inpatient bed allocation scheme can lead to significant reductions in bed allocation delays for ED patients (nearly up to ∼ 50 % ) and does not increase delays for other admission sources. The insights from our model should guide hospital managers in embracing proactive coordination and adaptive workflow technologies enabled by modern health information technology systems and predictive analytics.

中文翻译：

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主动协调住院病床管理以减少急诊科病人的寄宿

摘要 世界各地的急诊科 (ED) 都面临着严重的拥挤和延长的患者入院等待时间（又名患者“登机”）。使用来自主要医疗保健系统的数据，我们表明急诊室遭受严重的寄宿不仅是由于医院住院床位占用率高，而且还由于住院床位管理活动的被动协调。为了减少患者寄宿，我们探索了跨医院急诊室和住院病房的服务网络的早期任务启动。特别是，我们研究了在 ED 护理过程中预测 ED 患者入院（具体而言，处置决定）的价值，以主动启动下游任务以减少患者登机。我们表明，协调机制可以建模为分叉加入排队系统。提议的建模框架考虑了不完善的患者处置预测和住院病房的多个入院来源（除了 ED）。我们通过马尔可夫假设表征状态集和转换序列，从而保持分析的易处理性，同时保持现实世界住院病床管理操作的复杂性。主动住院病床分配方案可以显着减少急诊患者的床位分配延迟（近 50%），并且不会增加其他入院来源的延迟。我们模型的见解应指导医院管理人员采用由现代健康信息技术系统和预测分析支持的主动协调和自适应工作流技术。