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Management of Emergency Demand
Abstract
Is it time to consider remodelling the ambulance service? This is a question that emanates from the nature of competing requirements of public expectation and rising emergency demand, all against the backdrop of a reducing health sector finances and significant changes to the healthcare system itself. The increase in demand for ambulance services is being seen everywhere—possibly driven by a combination of an ageing population beset by multiple illnesses combined with urbanisation and fragmentation of communities. This has resulted in ambulance services struggling to meet the exacting response standards expected for potential emergencies irrespective of demographics or geography, whilst also providing an acceptable service to less urgent but nonetheless individually concerning health concerns.
... There is a growing trend in terms of share of employment in the service economy over the last few decades [1]. Accordingly, demand for health care services is permanently increasing and the same trend is expected in the future [2][3][4][5]. Increased demands for the quality and extent of health care usually coincide with reduced spending on health care systems, thus various countries face the same challenges of limited resources, increasing costs and heightened demands for services [6]. As the largest share of health care expenditure is financed by public sources, the efficient decisions are not only a purely technical and financial problem but may be seen as an issue of public interest in broader terms [7]. ...
The nature of health care services is very complex and specific, thus delays and organizational imperfections can cause serious and irreversible consequences, especially when dealing with emergency medical services. Therefore, constant improvements in various aspects of managing and organizing provision of emergency medical services are vital and unavoidable. The main goal of this paper is the development and application of a binary programming model to support decision making process, especially addressing scheduling workforce in organizations with stochastic demand. The necessary staffing levels and human resources allocation in health care organizations are often defined ad hoc, without empirical analysis and synchronization with the demand for emergency medical services. Thus, irrational allocation of resources can result in various negative impacts on the financial result, quality of medical services and satisfaction of both patients and employees. We start from the desired staffing levels determined in advance and try to find the optimal scheduling plan that satisfies all significant professional and regulatory constraints. In this paper a binary programming model has been developed and implemented in order to minimize costs, presented as the sum of required number of ambulance crews. The results were implemented for staff rostering process in the Ambulance Service Station in Subotica, Serbia. Compared to earlier scheduling done ad hoc at the station, the solution of the formulated model provides a better and equable engagement of crews. The developed model can be easily modified and applied to other organizations with the same, stochastic, nature of the demand.
... Nowadays, when the demand for medical services is growing (Calkins et al., 2016;Eastwood et al., 2015;Veser et al., 2015;Williams, 2015) and the same trend is expected in the future, demand analysis has become an increasingly important area in every organization. On the other hand, due to serious financial difficulties in most of the countries, budgets became even more limited and reduced. ...
In order to provide the best possible healthcare, managers need effective methods for decision making, as well as effective methods for management and improvement of a healthcare organization. Analysis of the demand is one of the key issues in healthcare organizations in that provides a reliable basis for efficient planning of future activities, of necessary material and financial and human resources. The main aim of this paper is to present the practical implementation of various quantitative methods in order to improve planning and organization of ambulance stations in Serbia. The results of detailed statistical analyses show that demand for emergency medical services follows some hourly, daily and monthly patterns. Observed regularities of the demand should be incorporated in operational, tactical and strategic plans of healthcare organizations in order to improve efficiency and achieve optimal allocation of scarce resources.
To measure the growth in emergency ambulance use across metropolitan Melbourne since 1995, to measure the impact of population growth and ageing on these services, and to forecast demand for these services in 2015.
A population-based retrospective analysis of Ambulance Victoria's metropolitan emergency ambulance transportation data for the period from financial year 1994-95 to 2007-08, and modelling of demand in the financial year 2014-15.
Numbers and rates of emergency ambulance transportations.
The crude annual rate of emergency transportations across all age groups increased from 32 per 1000 people in 1994-95 to 58 per 1000 people in 2007-08. The rate of transportation for all ages increased by 75% (95% CI, 62%-89%) over the 14-year study period, representing an average annual growth rate of 4.8% (95% CI, 4.3%-5.3%) beyond that explained by demographic changes. Patients aged ≥ 85 years were eight times (incident rate ratio, 7.9 [95% CI, 7.6-8.3]) as likely to be transported than those aged 45-69 years over this period. Forecast models suggest that the number of transportations will increase by 46%-69% between 2007-08 and 2014-15, disproportionately driven by increasing usage by patients aged ≥ 85 years.
These findings confirm a dramatic rise in emergency transportations over the study period, beyond that expected from demographic changes. Rates increased across all age groups, but more so in older patients. In the future, such acceleration is likely to have major effects on ambulance services and acute hospital capacity. This calls for further investigation of underlying causes and alternative models of care.
We analyzed regional characteristics that potentially might affect regional demand for emergency medicine in Yokohama city and projected the number of future ambulance users.
The number of patients transported by ambulance was regarded as an index of the demand for emergency medicine. Various factors that may affect regional demand for emergency medicine were used as dependent variables in multiple regression analysis. The future population was estimated by the cohort change rate method based on the 1995 and 2000 censuses. Data pertaining to ambulance use were obtained from the Annual Fire Fighting Bulletin, Yokohama. Data pertaining to regional factors were obtained from the Annual Health Statistics Report, Yokohama; the Annual Health Statistics Report, Kanagawa; and the Statistics Report, Yokohama.
Statistically significant relations were observed between ambulance use per 1000 population and particular regional characteristics, i.e. the proportion of persons undergoing health examinations conducted by public health centers, the number of educational health promotion programs managed by the public sector, the proportion of persons in receipt of livelihood protection, the proportions of roads and commercial areas in each district in relation to the total area, the mean land price, the age-adjusted mortality rate, and the proportion of persons aged 65 years or over. The demand for emergency medicine in Yokohama city was predicted to increase dramatically as the population ages. The number of patients transported by ambulance, which was 121,606 in 2000, was projected to exceed 250,000 in 2030 and to approximate 300,000 in 2050.
The demand for emergency medicine will increase dramatically in Yokohama city as the society ages, Regional emergency medical systems should be improved accordingly.
An Emergency Medical Service (EMS) can be defined as “a comprehensive system which provides the arrangements of personnel, facilities and equipment for the effective, coordinated and timely delivery of health and safety services to victims of sudden illness or injury.”1 The aim of EMS focuses on providing timely care to victims of sudden and life-threatening injuries or emergencies in order to prevent needless mortality or long-term morbidity. The function of EMS can be simplified into four main components; accessing emergency care, care in the community, care en route, and care upon arrival to receiving care at the health care facility.2
ambulance diversion is a dangerous repercussion of emergency department (ED) crowding and can reflect fragmentation and a lack of coordination in designating optimal patient offload sites for prehospital providers. The objective of this study was to evaluate whether proactive destination selection through the Regional Emergency Patient Access and Coordination (REPAC) program would enhance capacity and ED flow management.
the REPAC system provides a dashboard that synthesizes real-time capacity and acuity data for all three adult EDs in the city of Calgary, assigning a color code to reflect receiving status. It assigns destination for the next patient transported by emergency medical services (EMS) by categorizing ED sites as having either a favorable (green/yellow) status or unfavorable (orange/red) status. Three time windows were analyzed: a 6-month window prior to REPAC implementation (pre), the first 6-month window immediately following (post1), and the second 6-month period following (post2). Primary outcomes of interest were the proportion of time spent in favorable versus unfavorable status and EMS avoidances for all adult ED sites in the region (percentage of total time with any center on EMS bypass). Information on total number of ED visits, percentage of patients arriving by EMS transports, admission rates, patient acuity (Canadian Triage and Acuity Score), age, and length of stay (LOS) for admitted and discharged patients was collected. The Kruskal-Wallis test was employed for primary outcome analysis.
implementation of the REPAC system resulted in an increase in the proportion of total time region hospitals reported favorable status (57.5% vs. 64.1%) pre versus post1, an effect that was accentuated at 1 year (post2, 78.7%; p < 0.001 for both comparisons). There was a concomitant decrease in EMS avoidances as a result of the REPAC system, 4.4% to 1.8% (pre vs. post1), also further improved at 1 year to 0.6% (p < 0.001 for both comparisons).
proactive EMS destination selection through a real-time integrated electronic surveillance system enhances regional capacity and flow management while significantly reducing ambulance diversions.
Tackling demand together: A toolkit for improving urgent and emergency care pathways by understanding increases in 999 demand
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