Queuing Network Analysis Of Patient Flow And Resource Allocation: A Case Study Of Lagos And Ogun States

ABSTRACT

Over the years, allocation of scarce resources by hospital administrators and health policy makers to satisfy patient/consumer demands pose a serious challenge despite the fact that more resources are being allocated into the healthcare sector. Consequently, congestion in facilities which causes many patients to unnecessarily spend extra hours or days in emergency department and intensive care unit becomes inevitable. Therefore, this study aims at determining the optimal bed allocation over emergency department and intensive care unit in selected hospitals in Nigeria. The study also describes the capacity utilization and management of Lagos University Teaching Hospital (LUTH) and Olabisi Onabanjo University Teaching Hospital (OOUTH) Emergency Department (ED) and Intensive Care Unit (ICU) using a decomposed queuing network model to construct a useful model for estimating optimal bed unavailability. Based on historical data obtained from the hospitals, using proper queuing models (M/M/∞ and M/M/c) and patient delay standards, optimal number of beds was determined for each unit. The results of M/M/∞ analysis show that in LUTH  ED and OOUTH ED, patients spent .6666 days (16 hours) and .57 day (14 hours) in the queuing system respectively. In case of ICU, patients in LUTH and OOUTH spent .36 days (8.6 hours) and 1.786 days (42.86 hours). M/M/C Model analysis revealed that if the units operated at delay objective standard of 1%, LUTH and OOUTH EDs required over 64 and 16 beds against the existing 61 and 14 beds respectively. Similarly, LUTH and OOUTH ICUs’ optimal number of beds to serve existing population are more then 6 and 4 respectively. The content analysis reveals that better management of patient flow is crucial to reduce or avoid ED overcrowding and ICU patient rejection. It was also revealed that inadequate medical specialists and modern technology are most the serious problems confronting ED and ICU.  Based on these findings, to improve patient flow requires that hospital administrators should manage the arrival rate by different appointment methods such as online appointment management system to spread arrivals and call in appointment system. Sound and comprehensive data documentation system is required to in order to improve the quality of database which is a prerequisite for any sound empirical research. Bed capacity planning should be a function of system performance indices not using target occupancy levels as the primary determinants. The central focus of the hospital management and health policy makers should be to address the issue of inadequate bed in the EDs and ICUs to improve service delivery and reduce the patient waiting time. Hospital managers should know that relationship between size and quality of service is a vital issue in capacity planning. If international standard of health delivery and the recommended waiting time in ED and ICU are to be achieved, attention must be on acquisition of modern technology and recruitment of more medical professionals that specialize in ED and ICU operations.