Author:

Keywords:

Markov-modulated fluid queue, Emergency department, Boarding, Bed block

Abstract:

This article uses a Markov-modulated fluid queue approach to gain insights into the effect of boarding patients on emergency department performance. Important features of the network are (1) a semi-open structure to model limited bed capacity in addition to a limited physician capacity, (2) inpatient boarding, and (3) discontinuous treatment where patients may visit the physician more than once. Our analysis is numerical and exact: moreover, it is faster than the standard Quasi-birth-death method and simplifies the calculation of service levels in the external queue. We observe that boarding-reducing policies that focus on decreasing the boarding time perform better than policies that focus on decreasing the probability of boarding.