3.5 mbpf. a triage system has been proposed for the er described in exercise 3.4. as mentioned...

3.5 MBPF. A triage system has been proposed for the ER described in Exercise 3.4. As mentioned earlier, 55 patients per hour arrive at the ER. Under the proposed triage plan, entering patients will classify them as Simple Prescriptions or Potential Admits. While Simple Prescriptions will move on to an area staffed for regular care, Potential Admits will be taken to the emergency area. Planners anticipate that the initial examination will take 3 minutes. They expect that, on average, 20 patients will be waiting to register and 5 will be waiting to be seen by the triage nurse. Recall that registration takes an average of 2 minutes per patient. Planners expect eh Simple Prescriptions area to have, on average, 15 patients waiting to be seen. As before, once a patient’s turn come, each will take 5 minutes of a doctor’s time. The hospital anticipates that, on average, the emergency area will have only 1 patient waiting to be seen . As before, once that patient’s turn comes, he or she will take 30 minutes of a doctor’s time. Assume that, as before, 90% of all patients are Simple Prescriptions, assume, too, that the triage nurse is 100% accurate in making classifications. Under the proposed plan, how long on average, will a patient spend in the ER? On average, how long will a Potential Admit spend in the ER? On average, how many patients will be in the ER? Assume the process to be stable; that is, average inflow rate equals average outflow rate.

Directions

• o) Draw the flow process chart• a) On average how many patients are in ER?• b) On average, how long a patient spend in ER?• Hints:• Average flow rate is still 55 per hour (50 is typo) • Planners estimate that initial examination takes 3 minutes. It is

the flow time in triage activity. It is 3 it is not 1. One, as we will see in the future chapters is an estimate for the theoretical flow time.

• Compute average flow rate in buffer 3 and buffer 4. • Compute average flow time in all buffers.

• Compute average number of patients in all activities.

Buffer 1 Registration Buffer 2 Triage Nurse

Buffer 3 Potential admits

Buffer 4 Simple Prescription

55/hr

5.5/hr

49.5/hr

R R/min I TBuffer 1 55 0.916667 20Registeration 55 0.916667 2Buffer 2 55 0.916667 5Triage Nurse 55 0.916667 3Buffer 3 5.5 0.091667 1Potential Admission 5.5 0.091667 30Buffer 4 49.5 0.825 15Simple Prescription 49.5 0.825 5

Problem 3.5

R R/min I TBuffer 1 55 0.916667 20 21.8Registeration 55 0.916667 1.8 2Buffer 2 55 0.916667 5 5.5Triage Nurse 55 0.916667 2.8 3Buffer 3 5.5 0.091667 1 10.9Potential Admission 5.5 0.091667 2.8 30Buffer 4 49.5 0.825 15 18.2Simple Prescription 49.5 0.825 4.1 5

IER= 52.5a) On average, how many patients are in ER?

Method 1: Macro Method, a single flow unit

RER= 55/60 flow units per minute

IER= 52.5

b) On average, how long will a patient spend in ER?

TER = 52.5/(55/60) = 57.2 minutes

R R/min I TBuffer 1 55 0.916667 20 21.8Registeration 55 0.916667 1.8 2.0Buffer 2 55 0.916667 5 5.5Triage Nurse 55 0.916667 2.8 3.0Buffer 3 5.5 0.091667 1 10.9Potential Admission 5.5 0.091667 2.8 30.0Buffer 4 49.5 0.825 15 18.2Simple Prescription 49.5 0.825 4.1 5.0

Method 2: Micro Method, two flow units, Potential Admission and Simple Prescription

TPA= 21.8+2+5.5+3+10.9 +30 = 73.2

TSP= 21.8+2+5.5+3+18.2 +5 = 55.5

TER= .1(73.2)+.9(55.5) = 57.3

b) On average, how long will a patient spend in ER?

c) On average, how long will a potental admission patient spend in ER? 73.2

3.6 MBPF. Refer again to Exercise 3.5. Once the triage system is put in place, it performs quite close to expectations. All data conform to planners’ expectations except for one set-the classifications made by the nurse practitioner. Assume that the triage nurse has been sending 91% of all patients to the Simple Prescription area when in fact only 90% should have been so classified. The remaining 1% is discovered when transferred to the emergency area by a doctor. Assume all other information from Exercise 3.5 to be valid. On average, how long does a patient spend in the ER? On average, how long does a Potential Admit spend in the ER? On average, how many patients are in the ER? Assume the process to be stable; that is, average inflow rate equals average outflow rate.

Directions

• o) Draw the flow process chart

• b) On average how many patients are in this process?

• c) On average, how long a patient spend in this process?

• Hints:

• Compute flow rates at Buffer 3

• Compute flow rates at Buffer 4




55/hr

4.95/hr

50.05/hr

0.55/hr


Problem 3.6

5.5




55/hr

4.95/hr

50.05/hr

0.55/hr


Problem 3.6

R R/min I TBuffer 1 55 0.916667 20 21.8Registeration 55 0.916667 1.8 2Buffer 2 55 0.916667 5 5.5Triage Nurse 55 0.916667 2.8 3Buffer 3 5.5 0.091667 1 10.9Potential Admission 5.5 0.091667 2.8 30Buffer 4 50.05 0.834167 15 18.0Simple Prescription 50.05 0.834167 4.2 5

Macro: Average number of patients in the system = 20+1.8+5+2.8+1+2.8+15+4.2 = 52.6Average flow time = 52.6/(55/60) = 57.3

R R/min I TBuffer 1 55 0.916667 20 21.8Registeration 55 0.916667 1.8 2Buffer 2 55 0.916667 5 5.5Triage Nurse 55 0.916667 2.8 3Buffer 3 5.5 0.091667 1 10.9Potential Admission 5.5 0.091667 2.8 30Buffer 4 50.05 0.834167 15 18Simple Prescription 50.05 0.834167 4.2 5

Re-CheckMicro MethodCommon = 21.8 +2+5.5+3 = 32.3

Re-Check againT= 55.3 (49.5/55) + 73.2 (4.95/55) + 96.2 (.55/55)

T= 57.32 (re-check)

TSP= 32.3+18+5 = 55.3

TSP= 55.3 is 90% of flow units, and TPA =75.5 is for 10% of flow units

T = 55.3 (.9) + 75.5(.1) = 57.32

TPA1= 32.3 +10.9+30 = 73.2 ……(4.95 PA patients out of 5.5 PA patient: 90%)

TPA2= 73.2+18+5 =96.2 (0.55 PA patients out of 5.5 PA patient: 10%)

TPA = 73.2(.9) + 96.2(.1) =75.5

3.5 mbpf. a triage system has been proposed for the er described in exercise 3.4. as mentioned...

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