Improving Emergency Department Efficiency: A Study of Physician Scheduling Strategies to Reduce Patient Wait Times

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Prolonged wait times and overcrowding in emergency departments (EDs) represent significant national challenges in Canada. Within this thesis, I examine three distinct approaches aimed at assisting managers, decision-makers, and schedulers within EDs in addressing these pressing issues. Emergency departments serve as the initial point of contact for patients within the healthcare system, constituting a crucial yet interconnected component of healthcare provision. This study narrows its focus to the aspect of physician scheduling within EDs, recognizing its pivotal role in mitigating wait times and improving efficiency. The initial focus of my investigation lies in optimizing physician schedules within EDs to align with the fluctuating supply and demand dynamics. Extensive literature review and our own dataset reveal the variable productivity levels among physicians in these settings. In this thesis, productivity primarily refers to the number of new patients seen (or treated) by a physician per hour of their shift—a crucial metric in our pursuit of reducing patient wait times. Acknowledging this variability, I first delve into incorporating physician productivity (measured in Patients Per Hour, or PPH rate) into a staffing and shift scheduling problem for physicians. Numerical results show that significant improvements can be obtained in terms of average wait times for patients if we consider the variable productivity if physicians in the staffing and shift scheduling problem. Despite the optimization of schedules, the inherent stochastic nature of ED operations implies occasions where patient volumes exceed expectations, which lead to increased wait times. In response to these fluctuations, in the second and third studies, I propose and assess two distinct strategies aimed at managing ED crowding levels. Particularly, I derive optimal policies for EDs on when and how to extend physicians' shifts or call in physicians in response to a surge in demand. Using the simulation model to evaluate these strategies, I show the effectiveness of having flexibility in physicians schedules in reducing the average wait time of patients.
Ganjouhaghighi, N. (2024). Improving emergency department efficiency: a study of physician scheduling strategies to reduce patient wait times (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from