Between admission and wards: patient waiting time analysis using software engineering techniques Student : Abdullah Almeshal Supervisor : Dr. Shaowen Qin

Outlines Background & Emergency Departments problem Previous Studies The aim of this project Project methodology conclusion

Hospital Departments Hospital In-PatientOut-Patient Emergency Department (ED) Wards Clinics Adult care Pediatric care Triage

ED problem  Overcrowded Its a worldwide problem [5] Access block Ambulance services could be affected Delay in bed allocation The waiting time from the bed request to transfer the patient to that bed [5] Patient could die in ED bed. Patient could develop a serious complication.

Previous Studies 1. Alnoor public Hospital in Makah, Saudi Arabia [1] Delay in bed allocation.Waiting time for a bed to be available > 4hr Workflow process 2.Aga Khan University hospital in Karachi, Pakistan [2] Waiting time for a bed to be available > 6hr Limited bed assigned to ED patients. Late patient discharge. Single ward’s specialty. Increase ED share of in-patient beds Standardized discharge time Generalized wards specialties

Cont Ontario’s EDs in Canada [3] Waiting time for a bed to be available > 4hr Bed availability. increase in ED presentation vs. Decreases in beds Growth in population. Shortage in nurses Canadian Average nurse / (74.6) vs. Actual nurse / (67.6) Increase the hospital bed capacity Increase the nurse recruitment

Cont.... Flinders Medical Centre (FMC) emergency department [4] In 2003, ED presentation. 40% of them was admitted. 140 ED presentation twice a week every week for a year Delay in bed allocation.Waiting time for a bed > 8hr 30 % of hospital beds consider outlier ward beds ED patients leave unseen. Many FMC’s staff were prepared to leave.

Cont…. Redesigning program started in November 2003 Lean thinking approach was used. ED staff can handle patients per day. Delay in bed allocation reduced to 7 hr outlier wards reduced to 10% Patient leave unseen number reduced to 500. The ED staff turn over reduced.

The aim of this project is to: Identify what cause the delay in bed allocation Suggest solutions or recommendation to reduce the delay in admission. This project is study the delay in bed allocation at ED in FMC. The aim of this project Can software engineering techniques and tools help in identify the causes of delay in bed allocation at FMC emergency department?

The methodology Requirement specification Model ED process by creating an activity diagram Verification process “ is the model right?” Validation process “ Have we got the right model?” Analyzing the data provided by FMC. Take in consideration external factor affecting each process during modeling. Suggest solution based on the analysis and findings Identify the causes of delay in bed allocation

The project plan March 2011 Week 1 week 2 week 3 week 4 Literature review April 2011 Preparing for the 12 of April presentation create the activity diagram Verification & validation process May 2011 Analyzing the data Identify the causes suggest solutions June 2011 prepare the poster present the poster submit the final document.

Conclusion EDs worldwide are facing a problem of overcrowded which leads to unpleasant sequences. Many studies conducted to determine the causes of this problem, and most of them agree that delay in bed allocation the main cause for overcrowded. ED at FMC is one of the EDs facing this problem. Yet, this project is to identify the causes of overcrowded in FMC’s ED by using software engineering techniques and tools.

References 1.Tashkandy M, Gazzaz Z, Farooq M, Dhafar K, " Reasons for delay in inpatient admission at an emergency department“.J Ayub Med Coll Abbottabad. vol 20. iss(1). 2. Rehmani R, " Emergency Section and Overcrowding in a University Hospital of Karachi, Pakistan". Journal of Pakistani Medical Association.vol.5, iss5 3.Drummond A 2002, “ No room at the inn: Overcrowding in Ontario’s emergency departments”, CJEM.JCMU, vol.4, iss.2 4. Ben-Tovim D, Bassham J, Bennett D, Dougherty M, Martin M, O’Neil S, Sincock J, Scwarbord M, “ Redesigning care at the Flinders Medical Centre: clinical process redesign using “ lean thinking” “. MJA, vol.188 Iss.6. 5.Martin M, Champoin R, Kinsman L, Masman K, 2010, “ Mapping patient flow in a regional Australian emergency department: A model driven approach”, Nursing.