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Using agency analysis to develop a comprehensive understanding of throughput times in the emergency department

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Abstract

Typically patients in the emergency department experience long waiting times, primarily caused by process inefficiencies (Schellein et al. in Anaesthesist 58(2):163–170, 2009). Furthermore, the emergency departments have a significant impact on the revenue generation for the hospital (Schnellen 2008). Thus the emergency department should be made an important area of focus to design and develop appropriate measures for optimisation. Literature reports different inefficiencies such as “loss” of patients in the radiology (Andersson and Karlberg in Health Policy 55(3):187–207, 2001) or social loafing (Morton and Bevan in Health Policy 85(2):207–217, 2008). The present article adopts a socio-technical perspective and focuses on information asymmetries between the various actors as a key reason for these inefficiencies. In so doing, the paper provides an analysis of the emergency department using principal-agent theory (PAT), suggests a software-based monitoring system in order to reduce information asymmetries and evaluates this system in an empirical investigation.

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Notes

  1. e.g. Patient is already triaged, Patient is in the x-ray or he is still sitting in the waiting area

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Information Systems 2, University of Hohenheim, Schwerzstraße 35, 70599, Stuttgart, Germany

    Julia Fernandes, Marcus Müller & Stefan Kirn

  2. School of Business IT and Logistics, Epworth HealthCare and RMIT University, GPO Box 2476, Melbourne, VIC, 3001, Australia

    Nilmini Wickramasinghe

  3. Department of Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Germany

    Mark Dominik Alscher & Christoph Wasser

Authors
  1. Julia Fernandes
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  2. Marcus Müller
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  3. Nilmini Wickramasinghe
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  4. Stefan Kirn
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  5. Mark Dominik Alscher
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  6. Christoph Wasser
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Correspondence to Nilmini Wickramasinghe.

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The paper provides an analysis of the emergency department using principal-agent theory. The use of a software-based monitoring system is suggested in order to reduce information asymmetries and thereby the throughput times of patients. The longitudinal study with two independent samples in the ED was conducted in Bosch Hospital before and after the implementation of the monitoring system. Results show that the implementation of the monitoring system — I-DASH reduced the average time between triage and first contact with physician significantly for ‘very urgent’, ‘urgent’ and ‘standard’ patients. Besides the target time was kept significantly more frequently in the categories ‘very urgent’ and ‘standard’.

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Fernandes, J., Müller, M., Wickramasinghe, N. et al. Using agency analysis to develop a comprehensive understanding of throughput times in the emergency department. Health Technol. 3, 283–294 (2013). https://doi.org/10.1007/s12553-013-0061-8

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  • DOI: https://doi.org/10.1007/s12553-013-0061-8

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