INSIDE STORY
Another dose of O.R.
Many medical doctors study law on the side because in this litigious society, a law degree can come in handy, whether it’s trying to understand the healthcare reform bill, fending off malpractice suits or serving as an expert medical witness. Now, thanks to an increasingly competitive healthcare environment where information regarding hospital performance is widespread and patients act more like consumers making informed choices, doctors might consider studying industrial engineering in order to make their medical practice, department or hospital as efficient, and thus as competitive, as possible.
Consider the case of Dr. Joseph S. Guarisco, the chairman of the Department of Emergency Medicine and the system chief of Emergency Services for the Ochsner Health System in Louisiana. The Ochsner Health System manages seven emergency departments (ED) which combined have more than 250,000 visits a year.
About 10 or 15 years ago, emergency departments across the country began experiencing severe overcrowding. Studies point to several reasons for the crisis: a growing and aging population, people on Medicaid and Medicare seeking emergency treatment for minor complaints and a growing number of uninsured who had no other place to go coupled with shortages of emergency department facilities, inpatient beds and staff. The net result for patients: longer waits, poorer service and, in some instances, catastrophic outcomes.
Dr. Guarisco, who holds a bachelor’s degree in engineering, took a long, hard look at the overcrowding problem at Ochsner from an industrial engineering standpoint. He studied the patient-flow process, identified bottlenecks and, through the use of queueing theory and IE principles, created qTrack, a service delivery model that, as he explains in this month’s cover story, “cracked the code in addressing the chronic inability of hospitals to deliver emergency services on demand in an environment with high variability on both the demand side and the process side” (see “Rx for the ER,” page 30).
Dr. Guarisco’s story is the second in a series of articles in OR/MS Today on how operations research methodology and tools such as queueing theory and simulation can boost efficiency and help relieve the overcrowding crisis in emergency departments. It falls on the heels of “O.R. in the ER” in the August issue by Dr. David Eitel. Dr. Eitel, an emergency physician for 35 years and a physician advisor in case management for Wellspan Health System in York, Pa., is a co-inventor of the Emergency Severity Index Triage and a member of the ESI Triage Research Team. He became interested in operations research and management science in the mid-1990s while earning an executive MBA.
Doug Samuelson, an analytics consultant whose experience includes applying OR/MS to healthcare issues, served as co-author on both articles. Samuelson, a frequent contributor to OR/MS Today, first met Dr. Eitel at the INFORMS Healthcare 2011 Conference in June. Dr. Eitel subsequently introduced Samuelson to Dr. Guarisco, leading to not one but two articles on the ED overcrowding crises.
— Peter Horner, editor
peter.horner@mail.informs.org
For the Record
In this column in the August issue, we mistakenly indicated that William W. Cooper was the first president of ORSA. As several readers pointed out, Cooper was the first president of TIMS, not ORSA. The two organizations eventually merged to create INFORMS.
