Application of Queueing Theory In

AIIMS Hospital in Emergency

Department 1

Abstract: Emergency departments (EDs) are crucial healthcare settings where patient flow and
efficiency are paramount. Queueing theory, a mathematical framework for studying waiting lines, can be
applied to optimize patient flow in EDs. In this case study, we analyze the patient flow process in ED1,
where data on patient arrivals and registrations are available. We propose several interventions based on
queueing theory principles to optimize patient flow and reduce wait times, including staffing
optimization, process streamlining, registration process improvement, patient prioritization, and real-
time monitoring. Continuous monitoring and data-driven decision making are highlighted as essential in
ED operations.

Keywords: Emergency department, queueing theory, patient flow, wait times, interventions

Introduction: Emergency departments (EDs) are critical healthcare settings where efficient patient flow
is crucial for timely care and resource utilization. Queueing theory, a mathematical framework for
analyzing waiting lines, can provide insights into patient flow dynamics in EDs and inform interventions
for performance improvement. In this case study, we focus on the patient flow process in ED1, involving
patient arrival, EMT assessment, triage, doctor assessment, and registration. We have data on patient
arrivals and registrations and aim to apply queueing theory to optimize patient flow in ED1. Current
Patient Flow Process at ED1: The patient flow process at ED1 begins with patients arriving at the ED1,
and their arrival times are recorded. EMTs assess patients' vitals and assign them color-coded bands
based on severity. Patients then move to triage for doctor assessment. After doctor assessment, patients
register at the registration counter. Patients may be discharged or admitted for further treatment.

Components:
Arrival at ED1:- It follows the poison process with the constant arrival rate which is also known as
exponential process. Triage is performed by 2 EMTs and bands are given depending upon the situation of
the patient.

**Yellow and Red bands proceed further into the Emergency Section

Triage by Doctors: Doctors again check their vitals again to reassign the bands given to the patients.

Yellow(Y) & Red(R): The respective patients are treated until they become stable and bands given to
them are changed. In case of red if patients become critical need of surgery then ED2 or ED3 referral is
given, otherwise on band changing respective OPD assigned.

Arterial blood gas analysis (ABG) room: the tests are done for the patients
 Operational desk: This desk is used to manage all the operations regarding the transfer of patients,
maintaining results and keeping data and track of the patients.

Emergency Department Flow Chart

Triage by Doctors
(check bands)

Arrival at ED1
Y Operational
Triage by 2 EMTs Desk
(Bands Given)

Y : yellow band
patients

R: red band ABG

patients room

Emergency
Reception

OPD referral

Emergency Department 2 & 3 for further

treatment if required
Data Analysis and Findings: We analyzed the data on patient arrivals and registrations to understand
the patient flow process and identify areas for improvement. We calculated basic arrival rate metrics and
assessed variability in arrival times. We visualized patient arrival patterns over time and conducted a root
cause analysis to identify delays and waiting times. Our analysis revealed fluctuations in patient arrivals,
with peak hours showing higher volumes. EMT assessment times varied based on patient severity,
leading to wait time variability. Delays at the registration counter contributed to overall patient wait
times. Proposed Interventions: Based on our analysis and queueing theory principles, we propose the
following interventions to optimize patient flow and reduce wait times in ED1:

1. Staffing Optimization: Adjust staffing levels of EMTs and doctors during peak hours to match
demand, ensuring adequate resources and reducing wait times.

2. Process Streamlining: Review the EMT assessment process and identify opportunities for
streamlining, such as standardized protocols or technology utilization, to reduce variability in
wait times.

3. Registration Process Improvement: Analyze the registration process and implement

improvements, such as optimizing registration counters or electronic systems, to decrease
registration times and reduce patient wait times.

4. Patient Prioritization: Implement a prioritization system based on patient severity to expedite

care for critical patients and reduce overall wait times.

5. Real-time Monitoring and Decision-making: Implement a real-time monitoring system to track

patient flow metrics and make informed decisions for optimizing patient flow and reducing wait
times.

Conclusion: The application of queueing theory in analyzing and optimizing patient flow in ED1 can
provide valuable insights into patient arrivals, wait times, and resource utilization. Through the proposed
interventions, including staffing optimization, process streamlining, registration process improvement,
patient prioritization, and real-time monitoring, ED1 can potentially reduce patient wait times, improve
patient flow, and enhance operational efficiency. Continuous monitoring and data-driven decision
making are essential for ongoing improvements in ED performance. Further research and analysis can
assess the impact of these interventions and identify additional optimization opportunities in the ED
setting.