An optimization model to address overcrowding in emergency departments using patient transfer

Abstract

Overcrowding of emergency departments (EDs) is a problem that affected many hospitals especially during the response to emergency situations such as pandemics or disasters. Transferring nonemergency patients is one approach that can be utilized to address ED overcrowding. We propose a novel mixed-integer nonlinear programming (MINLP) model that explicitly considers queueing effects to address overcrowding in a network of EDs, via a combination of two decisions: modifying service capacity to EDs and transferring patients between EDs. Computational testing is performed using a Design of Experiments to determine the sensitivity of the MINLP solutions to changes in the various input parameters. Additional computational testing examines the effect of ED size on the number of transfers occurring in the system, identifying an efficient frontier for the tradeoff between system cost (measured as a function of the service capacity and the number of patient transfers) and the systemwide average expected waiting time. Taken together, these results suggest that our optimization model can identify a range of efficient alternatives for healthcare systems designing a network of EDs across multiple hospitals.