Purpose

Overcrowding continues to afflict emergency departments (EDs), and its attendant consequences are becoming increasingly severe. The burden of the COVID-19 pandemic is further escalating the situation worldwide. One of the most critical questions is how to adequately quantify what constitutes overcrowding and determine implications for operations management in improving service efficiency. This paper aims to discuss the aforementioned.

Design/methodology/approach

The authors propose the time and class complexity measures for ED service systems, taking into account important patient-level and system characteristics. Using an extensive data set from a Canadian ED, the authors investigate the performance of complexity-based measures in predicting service delays.

Findings

The authors find that the complexity measure is potentially more important than some well-known crowding metrics. In particular, EDs can improve service efficiency by managing the level of complexity within a desirable interval. Furthermore, complexity exposes how the interplay between demand-side behavioral changes and supply-side responses affects operational performance. Moreover, the results suggest that arrival patterns—the number of patients of each class arriving per time and times between events (arrivals and service completions)—increase the risk of service delays more than the demand volume.

Originality/value

This paper is the first to provide an extensive investigation into the application of the complexity-based measure for ED crowding. The study demonstrates potential values to be gained in ED service systems if complexity measure is incorporated into their operations management decisions.

中文翻译：

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基于复杂性的急诊科拥挤措施

目的

过度拥挤继续困扰着急诊科 (ED)，其后果也变得越来越严重。COVID-19 大流行的负担正在进一步加剧全球局势。最关键的问题之一是如何充分量化过度拥挤的原因，并确定对运营管理提高服务效率的影响。本文旨在对上述内容进行讨论。

设计/方法论/途径

作者提出了 ED 服务系统的时间和类别复杂性度量，并考虑到重要的患者级别和系统特征。作者使用加拿大急诊室的大量数据集，研究了基于复杂性的措施在预测服务延迟方面的性能。

发现

作者发现复杂性度量可能比一些众所周知的拥挤度量更重要。特别是，ED 可以通过在理想的时间间隔内管理复杂程度来提高服务效率。此外，复杂性揭示了需求方行为变化和供应方响应之间的相互作用如何影响运营绩效。此外，结果表明，到达模式（每次到达的每个类别的患者数量以及事件之间的次数（到达和服务完成））增加的服务延误风险大于需求量。

原创性/价值

本文首次对基于复杂性的急诊科拥挤测量方法的应用进行了广泛的研究。该研究表明，如果将复杂性衡量纳入运营管理决策中，急诊服务系统将获得潜在价值。