Controlling Excessive Waiting Times in Emergency Departments : An Extension of the ISA Algorithm

In an emergency department (ED), the demand for service is not constant over time. This cannot be accounted for by means of waiting lists or appointment systems, so capacity decisions are the most important tool to influence patient waiting times. Additional complexities result from the relatively small system size that characterizes an ED (i.e. a small number of physicians or nurses) and the presence of customer impatience. Assuming a single-stage multiserver M(t)=G=s(t) G queueing system with general abandonment and service times and time-varying demand for service, we suggest a method inspired by the simulation-based Iterative Staffing Algorithm (ISA) proposed by Feldman and others (2008) as a method to set staffing levels throughout the day. The main advantage of our extension is that it enables the use of performance measures based on the probability of experiencing an excessive waiting time, instead of the common focus on delay probability as a performance metric