Mitigating Overcrowding In The Emergency And Outpatient Department

Emergency department(ED)overcrowding has become a topic of intense interest around the world as closely associated with the quality of care,compromised patient outcomes,higher mortality rate,physicians as well as patients dissatisfaction,etc.ED overcrowding might base on various external and internal factors.An external factor might include inefficient operations in the specialty wards,bed management units(BMUs),laboratories,etc.Inpatient operations management is a very complicated phenomenon based on the various medical conditions.Consequently,poor patient flow due to inefficient operations led to bottlenecks and,ultimately,ED overcrowding(Zhao et al.,2015).Therefore,inpatient operations management was chosen to mitigate ED overcrowding in the National University Hospital(NUH),a leading public sector hospital in Singapore.Internal factors might include outpatients visiting ED with the minor medical condition.It was observed that about 68.6%of the patients visiting ED in the NUH were discharged based on stable medical conditions,casualties,or referrals to other hospitals.This 68.6%of the patients caught our attention.According to Uscher-Pines et al.(2013),at least 30%of the patients visiting ED in the U.S.are with minor medical conditions.Chinese territory-tier hospitals were facing the similar nature of challenges(Tu,Wang,&Wu,2015b).The ED of territory-tier hospitals in China were getting overcrowded even after enriching sufficient ED capacity(Li et al.,2016).While,primary health care resources in China were about 41%underutilization(Dan&Lam,2016).The Chinese government had realized the issue,therefore,determined to reduce outpatient flow from territory-tier hospitals,and to establish an effective referral system between territory-tier hospitals and primary care units(State Council,2015).Therefore,outpatient flow management was chosen to mitigate ED overcrowding from the territory-tier hospitals in China.In this thesis,we conducted three independent studies to deal with two research problems.The first one is a qualitative study and dealing with the inpatient operations management.In the first study,we used flowcharts to analyze the patient flow,and to identify the bottlenecks;used a fishbone diagram(Ishikawa)to do the cause and effect analysis;used scheduling to support inpatient operations management;dealt with resource management to achieve a maximum resource utilization rate;dealt with process management and related techniques in hospital operations.The first study contributes to four dimensions:Improving forecast mechanism that will help the BMU to schedule its internal transfers;Introducing two discharge rounds using effective scheduling and early discharge policy within the same timeframe required in the traditional discharge system,allowing for the discharge of more patients;Introducing a discharge lounge to make it possible to spare an inpatient bed right after the doctor makes the discharge decision;Lastly,application of lean techniques in healthcare setting.The second and third study is dealing with the outpatient flow management.The second one is a qualitative study and investigating an existing healthcare service delivery model in China.The third study is motivated by the second study in which we are proposing a mobile-based outpatient healthcare service delivery model.The proposed health care service delivery model can help to achieve optimal utilization of primary health care resources,and ultimately mitigation of ED overcrowding from the territory-tier hospitals in China.At then,the third study includes an empirical investigation to identify the factors influencing people's acceptance towards the proposed health care service delivery model.The data got collected from 626 respondents in China,while only 432 were found usable and analyzed using Smart PLS.The study revealed that perceived ease of use,perceived government support,perceived usefulness,and trust significantly influence intention to use m-health services equipped with public sector community health centers.Perceived ease of use significantly influences perceived usefulness and trust.Perceived government support significantly influences trust.Trust significantly affects perceived usefulness.