业务前沿:评估急诊科护理工作效率

Hao Ding, Sokol Tushe, Diwas Singh KC, Donald K. K. Lee
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摘要

问题定义:我们量化了急诊科(ED)因增加护士人数而提高的生产率。然后,我们估算医院的相关收入收益和社会的相关福利收益。在长期投资不足的助推下,美国十多年来经历了历史上最严重的护士短缺危机。为了向医院管理者和政策制定者展示护理投资的益处,我们阐明了在急诊室进行护理投资的积极下游效应。方法/结果:我们使用了美国一家大型学术医院急诊室病人就诊的高分辨率数据集。使用随时间变化的危险估计方法(非参数和参数)来研究病人的实时服务速度如何随急诊室的状态(包括指派护士随时间变化的工作量)而变化。通过反事实模拟来估算增加急诊室护理人员的收益。我们发现,护士的工作量减少一名病人,其护理的每名病人的服务速度就会提高 14%。模拟研究表明,在每天最繁忙的 12 小时轮班中增加一名护士,可缩短住院时间,并避免每 10,000 次就诊损失 160,000 美元的病人工资。服务时间的缩短还能腾出空间治疗更多病人,每 10,000 人次可为医院带来 47 万美元的额外净收入。广泛的敏感性分析表明,我们的关键信息--对护理的投资将得不偿失--很可能在各种急诊室都适用。管理意义:在决定是否投资更多护理资源时,医院管理者需要考虑的不仅仅是支付方的补偿是否足以支付前期成本,还要考虑由此带来的下游效益:本文已被《制造与amp; 服务运营管理》(Manufacturing & Service Operations Management Frontiers in Operations Initiative)收录:D. K. K. Lee 得到了美国国家心肺血液研究所 [Grant R01-HL164405] 的资助:在线附录见 https://doi.org/10.1287/msom.2023.0039 。
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Frontiers in Operations: Valuing Nursing Productivity in Emergency Departments
Problem definition: We quantify the increase in productivity in emergency departments (EDs) from increasing nurse staff. We then estimate the associated revenue gains for the hospital and the associated welfare gains for society. The United States is over a decade into the worst nursing shortage crisis in history fueled by chronic underinvestment. To demonstrate to hospital managers and policymakers the benefits of investing in nursing, we clarify the positive downstream effects of doing so in the ED setting. Methodology/results: We use a high-resolution data set of patient visits to the ED of a major U.S. academic hospital. Time-dependent hazard estimation methods (nonparametric and parametric) are used to study how the real-time service speed of a patient varies with the state of the ED, including the time-varying workloads of the assigned nurse. A counterfactual simulation is used to estimate the gains from increasing nursing staff in the ED. We find that lightening a nurse’s workload by one patient is associated with a 14% service speedup for every patient under the nurse’s care. Simulation studies suggest that adding one more nurse to the busiest 12-hour shift of each day can shorten stays and avert $160,000 in lost patient wages per 10,000 visits. The reduction in service times also frees up capacity for treating more patients and generates $470,000 in additional net revenues for the hospital per 10,000 visits. Extensive sensitivity analyses suggest that our key message—that investing in nursing will more than pay for itself—is likely to hold across a wide range of EDs. Managerial implications: In determining whether to invest in more nursing resources, hospital managers need to look beyond whether payer reimbursements alone are sufficient to cover the up-front costs to also account for the resulting downstream benefits.History: This paper has been accepted in the Manufacturing & Service Operations Management Frontiers in Operations Initiative.Funding: D. K. K. Lee was supported by the National Heart, Lung, and Blood Institute [Grant R01-HL164405].Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2023.0039 .
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