STREAMLINING EMERGENCY DEPARTMENT EFFICIENCY: IMPLEMENTING BUSINESS PROCESS RE-ENGINEERING TO REDUCE PATIENT WAIT TIMES
Keywords:
Business Process Re-engineering, Emergency Department, Wait Times, Efficiency, Hospital Service
Abstract
Background:
The Emergency Department (ED) plays vital roles in delivering emergency services for various clinical conditions. ED is required to provide health services even under high environmental pressures, such as overflowing patients, to speed up responsiveness. Therefore, efficiency should be a matter of concern in ED. The implementation of Business Process Re-Engineering (BPR) could significantly increase ED efficiency, specifically by reducing patient wait times.
Objective:
This study aims to review the relevant literature correlated to BPR and identify its roles in order to increase efficiency from the wait times.
Method:
We conducted a literature review with its reliable and replicable research protocol, which allowed the researchers to extract articles from PubMed, ProQuest and Google Scholars in recent 5 years using specific key words. The full text of relevant articles is then thematically synthesized and presented.
Results:
Our findings revealed that BPR implementation could affect the patients’ wait time reduction significantly by performing several procedures, such as applying Internet of Things (IoT) procedures, new layout design, staff allocation, applying heuristics method, simulation or event modelling procedures, and the technologies intervention.
Conclusion:
The BPR implementation has the potential to improve efficiency in the ED. However, it should be noted that the implementation of BPR needs to consider the ED necessity and a proper integration through existing health systems.
References
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Al-Surimi, K., Yenugadhati, N., Shaheen, N., Althagafi, M., & Alsalamah, M. (2021). Epidemiology of frequent visits to the emergency department at a tertiary care hospital in Saudi Arabia: rate, visitors’ characteristics, and associated factors. International Journal of General Medicine, 909–921.
Aldridge, E. S., Rogers, I. R., Bailey, P. M., & Rogers, J. R. (2016). Emergency department ‘undercrowding’is associated with decreased waiting times. Emergency Medicine Australasia, 28(3), 268–272.
Alowad, A., Samaranayake, P., Ahsan, K., Alidrisi, H., & Karim, A. (2021). Enhancing patient flow in emergency department (ED) using lean strategies–an integrated voice of customer and voice of process perspective. Business Process Management Journal, 27(1), 75–105.
Amarantou, V., Chatzoudes, D., Angelidis, V., Xanthopoulos, A., & Chatzoglou, P. (2023). Improving the operations of an emergency department (ED) using a combined approach of simulation and analytical hierarchical process (AHP). Journal of Simulation, 17(2), 193–210.
Baril, C., Gascon, V., & Vadeboncoeur, D. (2019). Discrete-event simulation and design of experiments to study ambulatory patient waiting time in an emergency department. Journal of the Operational Research Society, 70(12), 2019–2038.
Bhaskar, H. L., & Singh, R. P. (2014). Business process reengineering: a recent review. Bhaskar, HL, and Singh, RP (2014). Business Process Reengineering: A Recent Review. Global Journal of Business Management, 8(2), 24–51.
Bouzon Nagem Assad, D., & Spiegel, T. (2020). Improving emergency department resource planning: a multiple case study. Health Systems, 9(1), 2–30.
Dachyar, M., & Pertiwi, C. H. (2020). Improvement in Emergency Medical Services using Internet of Things (IoT). Hospital Emergency Department Case: a BPR Approach. 23rd Asian Forum of Business Education (AFBE 2019), 79–87.
Doan, Q., Wong, H., Meckler, G., Johnson, D., Stang, A., Dixon, A., Sawyer, S., Principi, T., Kam, A. J., & Joubert, G. (2019). The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study. Cmaj, 191(23), E627–E635.
Feuerwerker, S., Rankin, N., Wohler, B., Gemino, H., & Risler, Z. (2019). Improving patient satisfaction by using design thinking: patient advocate role in the emergency department. Cureus, 11(1).
Hammer, M., & Champy, J. (1994). Reengineering the corporation: A manifesto for business revolution. New York. Harper Collins, 1993. 233 pp.
Hammer, M., & Champy, J. (2009). Reengineering the corporation: Manifesto for business revolution, a. Zondervan.
Holden, R. J. (2011). Lean thinking in emergency departments: a critical review. Annals of Emergency Medicine, 57(3), 265–278.
Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: causes, effects, and solutions. Annals of Emergency Medicine, 52(2), 126–136.
Jansen-Vullers, M., & Reijers, H. (2005). Business process redesign in healthcare: towards a structured approach. INFOR: Information Systems and Operational Research, 43(4), 321–339.
Jeffery, M. M., D’onofrio, G., Paek, H., Platts-Mills, T. F., Soares, W. E., Hoppe, J. A., Genes, N., Nath, B., & Melnick, E. R. (2020). Trends in emergency department visits and hospital admissions in health care systems in 5 states in the first months of the COVID-19 pandemic in the US. JAMA Internal Medicine, 180(10), 1328–1333.
Jo, S., Jeong, T., Jin, Y. H., Lee, J. B., Yoon, J., & Park, B. (2015). ED crowding is associated with inpatient mortality among critically ill patients admitted via the ED: post hoc analysis from a retrospective study. The American Journal of Emergency Medicine, 33(12), 1725–1731.
Jones, S., Moulton, C., Swift, S., Molyneux, P., Black, S., Mason, N., Oakley, R., & Mann, C. (2022). Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emergency Medicine Journal, 39(3), 168–173.
Joseph, J. W., & White, B. A. (2020). How the emergency department works: a work in progress. Emergency Medicine Clinics, 38(3), xv–xvi.
Kelen, G. D., Wolfe, R., D’Onofrio, G., Mills, A. M., Diercks, D., Stern, S. A., Wadman, M. C., & Sokolove, P. E. (2021). Emergency department crowding: the canary in the health care system. NEJM Catalyst Innovations in Care Delivery, 2(5).
Kramer, A., Dosi, C., Iori, M., & Vignoli, M. (2020). Successful implementation of discrete event simulation: the case of an Italian emergency department. ArXiv Preprint ArXiv:2006.13062.
Kumar, A., & Shim, S. J. (2007). Eliminating emergency department wait by BPR implementation. 2007 IEEE International Conference on Industrial Engineering and Engineering Management, 1679–1683.
Leggat, S. G., Gough, R., Bartram, T., Stanton, P., Bamber, G. J., Ballardie, R., & Sohal, A. (2016). Process redesign for time-based emergency admission targets: Staff perceptions of the impact on quality of care. Journal of Health Organization and Management, 30(6), 939–949.
Lowthian, J. A., Curtis, A. J., Jolley, D. J., Stoelwinder, J. U., McNeil, J. J., & Cameron, P. A. (2012). Demand at the emergency department front door: 10‐year trends in presentations. Medical Journal of Australia, 196(2), 128–132.
Mahmood, M., Mahmood, N., & Mohammadreza, A. (2013). Determining the Level of Hospitalized Patients Satisfaction of Hospitals: A Systematic Review and Meta-Analysis. Hospital Journal, 12(1).
Manyazewal, T., Oosthuizen, M. J., & Matlakala, M. C. (2016). Proposing evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings: a summative analysis. BMJ Open, 6(9), e012582.
McNulty, T., & Ferlie, E. (2002). Reengineering health care: the complexities of organizational transformation. OUP Oxford.
Merliyanti, R., Meilando, R., & Agustiani, S. (2024). Faktor–faktor yang Berhubungan dengan Kecemasan Keluarga Pasien di IGD. Jurnal Penelitian Perawat Profesional, 6(1), 227–236.
Nurfadhilah, N., Sidin, A. I., & Kadir, A. R. (2021). Key Success Factors in Implementing Business Process Re-Engineering (BPR) in Hospitals: Integrative Review. Journal of Asian Multicultural Research for Medical and Health Science Study, 2(3), 60–72.
Olajide, O. T., Lawal, O. R., & Alaka, S. N. (2019). Effects of business process re-engineering on performance of selected hospitals in lagos state. Annals of the University of Craiova, Economic Sciences Series, 2(48).
Ouda, E., Sleptchenko, A., & Simsekler, M. C. E. (2023). Comprehensive review and future research agenda on discrete-event simulation and agent-based simulation of emergency departments. Simulation Modelling Practice and Theory, 102823.
Peng, Q., Yang, J., Strome, T., Weldon, E., & Chochinov, A. (2020). Evaluation of physician in triage impact on overcrowding in emergency department using discrete-event simulation. Journal of Project Management, 5(4), 211–226.
Pereira, R., Lapão, L. V., Bianchi, I. S., & Amaral, D. (2020). Improving emergency department through business process redesign: an empirical study. Australasian Journal of Information Systems, 24.
Pines, J. M., & Griffey, R. T. (2015). What we have learned from a decade of ED crowding research. Academic Emergency Medicine, 22(8), 985–987.
Putro, F., & Dachyar, M. (2020). Hospital surgical services design improvement using business process re-engineering and relational database approaches. International Journal of Advanced Science and Technology, 29(7), 3588–3596.
Sartini, M., Carbone, A., Demartini, A., Giribone, L., Oliva, M., Spagnolo, A. M., Cremonesi, P., Canale, F., & Cristina, M. L. (2022). Overcrowding in emergency department: causes, consequences, and solutions—a narrative review. Healthcare, 10(9), 1625.
Sasanfar, S., Bagherpour, M., & Moatari-Kazerouni, A. (2021). Improving emergency departments: Simulation-based optimization of patients waiting time and staff allocation in an Iranian hospital. International Journal of Healthcare Management, 14(4), 1449–1456.
Savioli, G., Ceresa, I. F., Gri, N., Bavestrello Piccini, G., Longhitano, Y., Zanza, C., Piccioni, A., Esposito, C., Ricevuti, G., & Bressan, M. A. (2022). Emergency department overcrowding: understanding the factors to find corresponding solutions. Journal of Personalized Medicine, 12(2), 279.
Srinivas, S., Nazareth, R. P., & Shoriat Ullah, M. (2021). Modeling and analysis of business process reengineering strategies for improving emergency department efficiency. Simulation, 97(1), 3–18.
Tian, Y., Basran, J., Stempien, J., Danyliw, A., Fast, G., Falastein, P., & Osgood, N. D. (2023). Participatory Modeling with Discrete-Event Simulation: A Hybrid Approach to Inform Policy Development to Reduce Emergency Department Wait Times. Systems, 11(7), 362.
Vasiliki, A., Prodromos, C., Vasiliki, K., & Dimitrios, C. (2017). Business process reengineering in emergency departments (EDs): Evidence from two hospitals. Advances in Applied Economic Research: Proceedings of the 2016 International Conference on Applied Economics (ICOAE), 349–363.
Volochtchuk, A. V. L., & Leite, H. (2022). Process improvement approaches in emergency departments: a review of the current knowledge. International Journal of Quality & Reliability Management, 39(2), 495–520.
Weng, S.-J., Tsai, M.-C., Tsai, Y.-T., Gotcher, D. F., Chen, C.-H., Liu, S.-C., Xu, Y.-Y., & Kim, S.-H. (2019). Improving the efficiency of an emergency department based on activity-relationship diagram and radio frequency identification technology. International Journal of Environmental Research and Public Health, 16(22), 4478.
Zaini, Z., & Saad, A. (2019). Business process reengineering as the current best methodology for improving the business process. Journal of ICT in Education, 6, 66–85.
Zamani, Z. (2022). Leveraging discrete event simulation modeling to evaluate design and process improvements of an emergency department. Journal of Design for Resilience in Architecture and Planning, 3(3), 397–408
Al-Surimi, K., Yenugadhati, N., Shaheen, N., Althagafi, M., & Alsalamah, M. (2021). Epidemiology of frequent visits to the emergency department at a tertiary care hospital in Saudi Arabia: rate, visitors’ characteristics, and associated factors. International Journal of General Medicine, 909–921.
Aldridge, E. S., Rogers, I. R., Bailey, P. M., & Rogers, J. R. (2016). Emergency department ‘undercrowding’is associated with decreased waiting times. Emergency Medicine Australasia, 28(3), 268–272.
Alowad, A., Samaranayake, P., Ahsan, K., Alidrisi, H., & Karim, A. (2021). Enhancing patient flow in emergency department (ED) using lean strategies–an integrated voice of customer and voice of process perspective. Business Process Management Journal, 27(1), 75–105.
Amarantou, V., Chatzoudes, D., Angelidis, V., Xanthopoulos, A., & Chatzoglou, P. (2023). Improving the operations of an emergency department (ED) using a combined approach of simulation and analytical hierarchical process (AHP). Journal of Simulation, 17(2), 193–210.
Baril, C., Gascon, V., & Vadeboncoeur, D. (2019). Discrete-event simulation and design of experiments to study ambulatory patient waiting time in an emergency department. Journal of the Operational Research Society, 70(12), 2019–2038.
Bhaskar, H. L., & Singh, R. P. (2014). Business process reengineering: a recent review. Bhaskar, HL, and Singh, RP (2014). Business Process Reengineering: A Recent Review. Global Journal of Business Management, 8(2), 24–51.
Bouzon Nagem Assad, D., & Spiegel, T. (2020). Improving emergency department resource planning: a multiple case study. Health Systems, 9(1), 2–30.
Dachyar, M., & Pertiwi, C. H. (2020). Improvement in Emergency Medical Services using Internet of Things (IoT). Hospital Emergency Department Case: a BPR Approach. 23rd Asian Forum of Business Education (AFBE 2019), 79–87.
Doan, Q., Wong, H., Meckler, G., Johnson, D., Stang, A., Dixon, A., Sawyer, S., Principi, T., Kam, A. J., & Joubert, G. (2019). The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study. Cmaj, 191(23), E627–E635.
Feuerwerker, S., Rankin, N., Wohler, B., Gemino, H., & Risler, Z. (2019). Improving patient satisfaction by using design thinking: patient advocate role in the emergency department. Cureus, 11(1).
Hammer, M., & Champy, J. (1994). Reengineering the corporation: A manifesto for business revolution. New York. Harper Collins, 1993. 233 pp.
Hammer, M., & Champy, J. (2009). Reengineering the corporation: Manifesto for business revolution, a. Zondervan.
Holden, R. J. (2011). Lean thinking in emergency departments: a critical review. Annals of Emergency Medicine, 57(3), 265–278.
Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: causes, effects, and solutions. Annals of Emergency Medicine, 52(2), 126–136.
Jansen-Vullers, M., & Reijers, H. (2005). Business process redesign in healthcare: towards a structured approach. INFOR: Information Systems and Operational Research, 43(4), 321–339.
Jeffery, M. M., D’onofrio, G., Paek, H., Platts-Mills, T. F., Soares, W. E., Hoppe, J. A., Genes, N., Nath, B., & Melnick, E. R. (2020). Trends in emergency department visits and hospital admissions in health care systems in 5 states in the first months of the COVID-19 pandemic in the US. JAMA Internal Medicine, 180(10), 1328–1333.
Jo, S., Jeong, T., Jin, Y. H., Lee, J. B., Yoon, J., & Park, B. (2015). ED crowding is associated with inpatient mortality among critically ill patients admitted via the ED: post hoc analysis from a retrospective study. The American Journal of Emergency Medicine, 33(12), 1725–1731.
Jones, S., Moulton, C., Swift, S., Molyneux, P., Black, S., Mason, N., Oakley, R., & Mann, C. (2022). Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emergency Medicine Journal, 39(3), 168–173.
Joseph, J. W., & White, B. A. (2020). How the emergency department works: a work in progress. Emergency Medicine Clinics, 38(3), xv–xvi.
Kelen, G. D., Wolfe, R., D’Onofrio, G., Mills, A. M., Diercks, D., Stern, S. A., Wadman, M. C., & Sokolove, P. E. (2021). Emergency department crowding: the canary in the health care system. NEJM Catalyst Innovations in Care Delivery, 2(5).
Kramer, A., Dosi, C., Iori, M., & Vignoli, M. (2020). Successful implementation of discrete event simulation: the case of an Italian emergency department. ArXiv Preprint ArXiv:2006.13062.
Kumar, A., & Shim, S. J. (2007). Eliminating emergency department wait by BPR implementation. 2007 IEEE International Conference on Industrial Engineering and Engineering Management, 1679–1683.
Leggat, S. G., Gough, R., Bartram, T., Stanton, P., Bamber, G. J., Ballardie, R., & Sohal, A. (2016). Process redesign for time-based emergency admission targets: Staff perceptions of the impact on quality of care. Journal of Health Organization and Management, 30(6), 939–949.
Lowthian, J. A., Curtis, A. J., Jolley, D. J., Stoelwinder, J. U., McNeil, J. J., & Cameron, P. A. (2012). Demand at the emergency department front door: 10‐year trends in presentations. Medical Journal of Australia, 196(2), 128–132.
Mahmood, M., Mahmood, N., & Mohammadreza, A. (2013). Determining the Level of Hospitalized Patients Satisfaction of Hospitals: A Systematic Review and Meta-Analysis. Hospital Journal, 12(1).
Manyazewal, T., Oosthuizen, M. J., & Matlakala, M. C. (2016). Proposing evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings: a summative analysis. BMJ Open, 6(9), e012582.
McNulty, T., & Ferlie, E. (2002). Reengineering health care: the complexities of organizational transformation. OUP Oxford.
Merliyanti, R., Meilando, R., & Agustiani, S. (2024). Faktor–faktor yang Berhubungan dengan Kecemasan Keluarga Pasien di IGD. Jurnal Penelitian Perawat Profesional, 6(1), 227–236.
Nurfadhilah, N., Sidin, A. I., & Kadir, A. R. (2021). Key Success Factors in Implementing Business Process Re-Engineering (BPR) in Hospitals: Integrative Review. Journal of Asian Multicultural Research for Medical and Health Science Study, 2(3), 60–72.
Olajide, O. T., Lawal, O. R., & Alaka, S. N. (2019). Effects of business process re-engineering on performance of selected hospitals in lagos state. Annals of the University of Craiova, Economic Sciences Series, 2(48).
Ouda, E., Sleptchenko, A., & Simsekler, M. C. E. (2023). Comprehensive review and future research agenda on discrete-event simulation and agent-based simulation of emergency departments. Simulation Modelling Practice and Theory, 102823.
Peng, Q., Yang, J., Strome, T., Weldon, E., & Chochinov, A. (2020). Evaluation of physician in triage impact on overcrowding in emergency department using discrete-event simulation. Journal of Project Management, 5(4), 211–226.
Pereira, R., Lapão, L. V., Bianchi, I. S., & Amaral, D. (2020). Improving emergency department through business process redesign: an empirical study. Australasian Journal of Information Systems, 24.
Pines, J. M., & Griffey, R. T. (2015). What we have learned from a decade of ED crowding research. Academic Emergency Medicine, 22(8), 985–987.
Putro, F., & Dachyar, M. (2020). Hospital surgical services design improvement using business process re-engineering and relational database approaches. International Journal of Advanced Science and Technology, 29(7), 3588–3596.
Sartini, M., Carbone, A., Demartini, A., Giribone, L., Oliva, M., Spagnolo, A. M., Cremonesi, P., Canale, F., & Cristina, M. L. (2022). Overcrowding in emergency department: causes, consequences, and solutions—a narrative review. Healthcare, 10(9), 1625.
Sasanfar, S., Bagherpour, M., & Moatari-Kazerouni, A. (2021). Improving emergency departments: Simulation-based optimization of patients waiting time and staff allocation in an Iranian hospital. International Journal of Healthcare Management, 14(4), 1449–1456.
Savioli, G., Ceresa, I. F., Gri, N., Bavestrello Piccini, G., Longhitano, Y., Zanza, C., Piccioni, A., Esposito, C., Ricevuti, G., & Bressan, M. A. (2022). Emergency department overcrowding: understanding the factors to find corresponding solutions. Journal of Personalized Medicine, 12(2), 279.
Srinivas, S., Nazareth, R. P., & Shoriat Ullah, M. (2021). Modeling and analysis of business process reengineering strategies for improving emergency department efficiency. Simulation, 97(1), 3–18.
Tian, Y., Basran, J., Stempien, J., Danyliw, A., Fast, G., Falastein, P., & Osgood, N. D. (2023). Participatory Modeling with Discrete-Event Simulation: A Hybrid Approach to Inform Policy Development to Reduce Emergency Department Wait Times. Systems, 11(7), 362.
Vasiliki, A., Prodromos, C., Vasiliki, K., & Dimitrios, C. (2017). Business process reengineering in emergency departments (EDs): Evidence from two hospitals. Advances in Applied Economic Research: Proceedings of the 2016 International Conference on Applied Economics (ICOAE), 349–363.
Volochtchuk, A. V. L., & Leite, H. (2022). Process improvement approaches in emergency departments: a review of the current knowledge. International Journal of Quality & Reliability Management, 39(2), 495–520.
Weng, S.-J., Tsai, M.-C., Tsai, Y.-T., Gotcher, D. F., Chen, C.-H., Liu, S.-C., Xu, Y.-Y., & Kim, S.-H. (2019). Improving the efficiency of an emergency department based on activity-relationship diagram and radio frequency identification technology. International Journal of Environmental Research and Public Health, 16(22), 4478.
Zaini, Z., & Saad, A. (2019). Business process reengineering as the current best methodology for improving the business process. Journal of ICT in Education, 6, 66–85.
Zamani, Z. (2022). Leveraging discrete event simulation modeling to evaluate design and process improvements of an emergency department. Journal of Design for Resilience in Architecture and Planning, 3(3), 397–408
Published
2024-06-21
How to Cite
TRIANA, I. K. D. L., Agustina, P. D. C., Febrian, R., Wiadnya, I. D. G. P., & Paramarta, V. (2024). STREAMLINING EMERGENCY DEPARTMENT EFFICIENCY: IMPLEMENTING BUSINESS PROCESS RE-ENGINEERING TO REDUCE PATIENT WAIT TIMES. Homes Journal: Hospital Management Studies Journal, 5(2), 120-131. https://doi.org/10.24252/hmsj.v5i2.46369
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Artikel
