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School of Business | Bachelor's thesis
Degree programme
Tieto- ja palvelujohtaminen
23 + 4
Overcrowding in emergency departments (EDs) is a highly reported phenomenon that burden both patients but also health care professionals. Length of stay (LOS) increases, health care professionals get frustrated, they make more errors and patients suffering from pain prolongs. The ED can be seen as a process where LOS is equal with throughput time (TPT). Patients are flowing from a phase to another and there can be waiting time between phases. Process type is then a job shop. There are multiple reasons for overcrowding that can be divided into three categories: input, throughput and output factors. Health care professionals and the managers can have little if any power to change problems behind input and output factors. The thesis is then focussing on throughput factors. Inadequate staffing and inappropriate layout of the ED are causing an increase in the TPT. For example, a new layout in a triage could be one solution for problem and especially a physician-lead triage has been studied. The triage is the part of the ED process that is evaluating need of care considering patient ́s medical condition. A physician in triage have decreased the LOS significantly. Patients in the ED can be seen as work in process (WIP) and overcrowding changes the character of process caused by increased WIP. For instance, complexity and uncertainty of process increase. Industrial engineering process management has been utilized to the ED process. TPT has decreased after applying the principles of Lean management. Cost savings have not still achieved. Based on my personal experience, the current system in EDs have problems in process design, communication and lack of collaboration between health care professionals. In this bachelor thesis, I aimed to decrease TPT by redesigning the layout of one walk-in ED in Uusimaa. The main idea was to highlight benefits of teamwork and to find a solution that reduces things unnecessarily repeated. Objective was an average throughput time (TPT) of a patient in the ED. The re-design in this bachelor thesis led to 6.75 % reduction in TPT. The data was based on my empirical findings, so evaluating the significancy is not possible. However, similar findings have been described in the literature. To critically evaluate the layout of the ED, similar calculations should be done with real-life data. Careful process design in the ED decreases TPT and helps with overcrowding problem. LOS of patients is only one objective to measure in real life. Population ́s life expectancy prolongs and need for medical care increases. To maintain current level of healthcare services, cost savings must be achieved. The effects of the process design on costs would be a relevant further topic of research.
Thesis advisor
Tinnilä, Markku
emergency department, throughput time, length of stay, -
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