Between admission and wards: patient waiting time analysis using software

engineering techniques

Student : Abdullah Almeshal

Supervisor : Dr. Shaowen Qin

Outlines• Background & Emergency Departments problem

• Previous Studies

• The aim of this project

• Project methodology

• conclusion

Hospital Departments

Hospital

In-Patient

Out-Patient

Emergency

Department (ED)

Wards

Clinics

Adultcare

Pediatric

careTriage

ED problem

Overcrowded

Its a worldwide problem[5]

• Access block• Ambulance services could be affected

Delay in bed allocationThe waiting time from the bed request to transfer the patient to that bed [5]

• Patient could die in ED bed. • Patient could develop a serious

complication.

Previous Studies 1. Alnoor public Hospital in Makah, Saudi Arabia [1]

• Delay in bed allocation.Waiting time for a bed to be available > 4hr

• Workflow process

2. Aga Khan University hospital in Karachi, Pakistan [2]

Waiting time for a bed to be available > 6hr

• Limited bed assigned to ED patients.• Late patient discharge.• Single ward’s specialty.

• Increase ED share of in-patient beds• Standardized discharge time• Generalized wards specialties

Cont....

3. Ontario’s EDs in Canada [3]

Waiting time for a bed to be available > 4hr

• Bed availability.• increase in ED presentation vs. Decreases

in beds• Growth in population.

• Shortage in nurses• Canadian Average nurse / 10000 (74.6) vs. Actual nurse /

10000 (67.6)

Increase the hospital bed capacity

Increase the nurse recruitment

Cont....

• Flinders Medical Centre (FMC) emergency department [4]

• In 2003, 45000 ED presentation. 40% of them was admitted.• 140 ED presentation twice a week every week for a year

• Delay in bed allocation.

Waiting time for a bed > 8hr

• 30 % of hospital beds consider outlier ward beds.• 1000 ED patients leave unseen.

• Many FMC’s staff were prepared to leave.

Cont….

• Redesigning program started in November 2003

• Lean thinking approach was used.

• ED staff can handle 180-210 patients per day.

• Delay in bed allocation reduced to 7 hr

• outlier wards reduced to 10%

• Patient leave unseen number reduced to 500.

• The ED staff turn over reduced.

The aim of this project is to: • Identify what cause the delay in bed allocation• Suggest solutions or recommendation to reduce the

delay in admission.

This project is study the delay in bed allocation at ED in FMC.

The aim of this project

Can software engineering techniques and tools help in identify the causes of delay in bed allocation at FMC emergency department?

The methodology

• Requirement specification

• Model ED process by creating an activity diagram • Verification process “ is the model right?” • Validation process “ Have we got the right model?”• Analyzing the data provided by FMC .

• Take in consideration external factor affecting each process during modeling.• Suggest solution based on the analysis and findings

• Identify the causes of delay in bed allocation

The project plan

March 2011Week 1 week 2 week 3 week 4

Literature review

April 2011

Preparing for the 12 of April presentation

• create the activity diagram • Verification & validation process

May 2011

• Analyzing the data • Identify the causes• suggest solutions

June 2011

• prepare the poster • present the poster

• submit the final document.

Conclusion

EDs worldwide are facing a problem of overcrowded which leads to unpleasant sequences . Many studies conducted to determine the causes of this problem, and most of them agree that delay in bed allocation the main cause for overcrowded. ED at FMC is one of the EDs facing this problem. Yet, this project is to identify the causes of overcrowded in FMC’s ED by using software engineering techniques and tools.

Thank You

References

1. Tashkandy M, Gazzaz Z, Farooq M, Dhafar K, 2008. " Reasons for delay in inpatient admission at an emergency department“ .J Ayub Med Coll Abbottabad. vol 20. iss(1).

2. Rehmani R, 2004. " Emergency Section and Overcrowding in a University Hospital of Karachi, Pakistan". Journal of Pakistani Medical Association.vol.5, iss5

3. Drummond A 2002, “ No room at the inn: Overcrowding in Ontario’s emergency departments”, CJEM.JCMU, vol.4, iss.2

4. Ben-Tovim D, Bassham J, Bennett D, Dougherty M, Martin M, O’Neil S, Sincock J, Scwarbord M, 2008. “ Redesigning care at the Flinders Medical Centre: clinical process redesign using “ lean thinking” “. MJA, vol.188 Iss.6.

5. Martin M, Champoin R, Kinsman L, Masman K, 2010, “ Mapping patient flow in a regional Australian emergency department: A model driven approach”, Nursing.