Maximising the patient flows throughout the emergency care patient pathway is one of the most important objectives in the healthcare system. The emergency department (ED) is the critical point of this pathway in most hospitals, as the potential delays reduce the number of patients seen in the recommended time. One of the key delays in the ED is the waiting time of a patient prior to treatment, which can be reduced by optimising the patient treatment schedules with priorities. In this paper, a novel blocking patient flow (BPF) algorithm is developed and tested using the real data from a hospital in Brisbane, Australia. Initially, a simulation model of real-life ED operations is developed by characterising patient interarrival and treatment times according to different disease categories. Subsequently, a BPF heuristic algorithm is designed and benchmarked via computational experiments using two dominance rules: first come first served (FCFS) and shortest processing time (SPT). The computational results show that the proposed approach leads to a reduction of the total waiting time by more than 8 % in comparison to the current hospital practice, which implies that more patients will be served in a specified time window.

Emergency department (ED) overcrowding is a common issue in emergency medicine of Canada. Previous studies indicate that adding a physician in triage (PIT) can increase accuracy and efficiency in the initial process of patient evaluations. However, the PIT concept should be thoroughly researched before its widespread implementation can be recommended. This paper introduces the evaluation of impact of PIT on ED patient wait times and length of stay (LOS) using simulation modeling. A discrete-event simulation model of ED is built to simulate and predict the effect of PIT intervention. The model performance is validated using current-state ED flow metrics to quantitatively test multiple alternatives for ED improvements. Results show that the PIT implementation can reduce the ED patient LOS by an average of 34% and Waiting to be Seen time by 49% across all scenarios studied. The proposed method can be applied to improve the operation efficiency of healthcare systems in the current pandemic, COVID -19.

Activity based costing (ABC) is a new age accounting system developed to overcome the limitations of traditional costing system, which in today’s technologically advanced world has lost its ability to provide accurate and useful cost information often required in taking various managerial decisions, like setting of selling price, ascertaining profitability of products as well as customers, taking a make or buy decision, eliminating the non-beneficial activities, and rewarding the employees. In this paper, an ABC model is developed for a government hospital in the state of Bihar in India to quantify its various public health related services. Although, there are limited published research papers related to application of ABC model in a specific department or method of a healthcare system, none of them has investigated its scope for organization-wide implementation. The results obtained from the developed ABC model in the public hospital would provide more comprehensive and accurate cost information, and radically contribute to the hospital administration in effective planning, controlling and decision making. This paper also elucidates about various obstructions and difficulties encountered during the implementation phase of ABC model in an Indian healthcare setting.