Valley Hospital: Managing Patient Flow in The Emergency Department

Abstract

Valley Hospital is a tertiary care hospital which services the immediate city of approximately 38,000 people. Valley is also part of a metropolitan community of four counties that has a total population of less 400,000. Each of the counties has a major population center with its own hospital. Over the last 15 years, Valley Hospital remodeled and enlarged its bed capacity as well as the size of its emergency department (ED) to keep up with the population growth of the community. As with most ED’s in hospitals, Valley Hospital had seen an increase in the number of patients and different types of cases which then increased the door-to-doctor, door-to-discharge and door-to-admission times. Dr. Tom Monroe, the acting director of emergency services, reviewed the data measuring door-to-discharge and door-to-admission times and felt that there must be a better way to manage the ED patient flow. He felt pressure from the community as well as hospital administration to reduce wait times and increase the productivity of the ED.

The primary subject matter of this case is the coordination issues in an ED. Secondary issues include discovering and understanding the major chokepoints in the flow of patients and suggesting some solutions to overcome them. The case has a difficulty level appropriate for senior students or first-year master students in an Operations Management or a Process Improvement in Healthcare course.