The encyclopedia · R&D & Science · Operational decision · 2015–2017
Mayo Clinic staffed its ER to a threshold, cutting length of stay 11 min
Classification trees found the patient-to-staff ratio that splits long stays from short; Mayo's new shifts cut LOS 11 min despite 6% more patients.
Mayo Clinic
the move
Emergency departments often staff to past volumes, which bakes in the inefficiency of the current shifts, or to arrivals, which ignores queueing.
Mayo used classification and regression trees to find patient-to-staff ratio thresholds that separate patients with long versus short ED stays.
Those thresholds defined an ideal patient volume, and a mixed-integer program minimized understaffing against it by designing new shift templates.
why it works
- Ratio thresholds capture the point where flow actually breaks.
- Avoids replicating the inefficiency already in old shifts.
- Mixed-integer programming explicitly minimizes understaffing.
- Results held even as patient volume rose 6%.
what transfers
Don't schedule to the number of patients; schedule to the staffing ratio at which patient flow deteriorates.
what came after
Implemented in the fourth quarter of 2015 at Mayo Clinic Saint Marys Hospital's adult-pediatric trauma ED, the new shift templates produced statistically significant improvements: median length of stay fell 11 minutes, door-to-provider time 2.7 minutes, and door-to-bed time 3 minutes, despite a 6% increase in patient volume.
references
- Optimization of Multidisciplinary Staffing Improves Patient Experiences at the Mayo Clinic
- Optimization of Multidisciplinary Staffing Improves Patient Experiences at the Mayo Clinic (seminar abstract)
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