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Emergency departments (EDs) are among the most intensive and dynamic departments in hospital systems. This study considers the resource allocation problem at the ED of a hospital with two objective functions: the length of stay (LS) and wasted resources. The numbers of doctors, nurses, lab technicians, and other medical equipment must be constantly determined to effectively operate EDs with the two objective functions, representing the satisfaction of patients and unnecessary costs, respectively. The ED system is evaluated with a discrete event simulation (DES) model. Furthermore, a Pareto optimal set of solutions is approximated using the quantile-relaxed multiple objective probabilistic branch and bound (QR-MOPBnB), which was developed as an extension algorithm of MOPBnB to improve efficiency. QR-MOPBnB iteratively branches the solution space into subregions and identifies the subregions that are the most promising to be close to the Pareto optimal set. Using QR-MOPBnB, the trade-off between the LS and wasted resources is illustrated for decision makers to appropriately determine the ideal design based on their preferences, and the relaxed Pareto optimal set with statistical quality assurance provides further insights similar to those obtained through sensitivity analysis.

Patient satisfaction in the developing world has not received sufficient interest in the healthcare literature. More importantly, models predicting patient satisfaction seldom incorporates patient perspectives into their measurement providing ill-suited metrics for healthcare administrators to make decisive decisions concerning service quality improvements. The current analysis utilizes original data collected from 336 patients in Jordan. This paper tests whether service quality (SERVQUAL) is suitable to be used in the new context and concluded that SERVQUAL is reliable and valid in supplying stakeholders with reliable and valid information concerning patient satisfaction. Further, the analysis suggests a large gap between perceived and expected services performed by Jordanian hospitals signalling the need to service quality enhancement. The study calls for the adoption of agile and rapid patient screening models in emergency departments to reduce wait times and decrease the number of patients left without being seen. This study constitutes an emerging attempt at better understanding how service quality influences patient satisfaction, and more importantly, introduce affordable and cost-effective solutions capable of improving satisfaction in the short run.

Healthcare systems engineering in emergency departments (EDs) are developing rapidly in the world nowadays. Fast track (FT) as a rapid treatment system is considered to facilitate ED patient flow. To know how FT can improve the performance of ED, one should study the best configuration of resources for implementation of FT. This research presents a pattern for implementation of FT systems in hospital EDs using healthcare simulation paradigms. Simulation-based optimization model uses modeling and simulation capabilities to generate configurations of FT resources and its patient prioritization pattern with Arena${}^{\mathrm{\text{®}}}$ simulation software. A decision making method is used to select the optimal configuration based on pre-specified performance indicators. The results imply that the proposed FT implementation pattern is efficient and capable of improving patient flow.

Background: The frequency of hand and elbow surgeries occurring in outpatient and elective settings is on the rise. Emergency department (ED) visits in the postoperative period are increasingly used as quality measures for surgical care. The aim of this study is to determine the number of postoperative ED visits, the primary reason for these visits, and to identify risk factors associated with these visits.

Methods: We examined all elective hand and elbow procedures performed at two hospitals within a single healthcare network between 2008 and 2017. A total of 3,261 patients met the study criteria. Descriptive statistics were calculated for our population, followed by univariate and multivariate analyses, to identify risk and protective factors associated with ED visits in the first 30 days after surgery.

Results: Eighty-seven of 3,261 patients presented to the ED within 30 days of their operation (2.7%). The most common reasons for ED visits were related to pain (28.7%), swelling (26.4%), and concerns for infection (20.7%). Univariate analysis indicated history of drug use, number of procedures, smoking history, and serum albumin <3.5 mg/dL as risk factors for returns to the ED. Multivariate analysis identified history of drug use, number of procedures, and serum albumin <3.5 mg/dL as independent risk factors. Smoking history failed to achieve statistical significance as an independent risk factor. Both univariate and multivariate analyses identified age >60 years as protective for postoperative ED visits.

Conclusions: ED visits within the first 30 days after elective hand surgery are relatively common, despite remarkably low complication rates among these procedures. This information may help to improve risk stratification in these patients, and to aid in the development of enhanced postoperative follow-up strategies to reduce unnecessary utilization of emergency medical services.

Level of Evidence: Level III (Therapeutic)

Background: Hand injuries are a significant and rising burden on the Emergency Department (ED), often leading to protracted waiting times for patients awaiting specialist input. To combat this, a new treatment pathway for hand trauma was introduced at our institution to reduce waiting times and pressure on the ED.

Methods: The treatment pathway performance using waiting times, length of stay and cost metrics was measured prior to and following the introduction of a new treatment pathway.

Results: There were 15,539 patients reviewed in total. After the new pathway had been introduced, the number of assessments in ED significantly reduced (Year 1: 907 [19.9%] vs. Year 2: 422 [7.9%]; p < 0.001), and the proportion of patients who had an operation on the same day that they were assessed significantly increased (69 [1.5%] vs. 403 [7.5%] patients; p < 0.001). The median waiting time from assessment to operation and length of stay also significantly reduced following the introduction of the treatment pathway (Year 1: 53 hours and Year 2: 45 hours; p < 0.001).

Conclusions: Our data over 3 years shows that these changes have been maintained and, in some cases, have continued to improve since the introduction of the new treatment pathway. We advocate the use of such an approach for all hand trauma centres worldwide to replicate these improvements in patient care.

Level of Evidence: Level III