Policies for physician allocation to triage and treatment in emergency departments

In the emergency department (ED), low-acuity patients divert resources from more critical patients. To facilitate flow, EDs are experimenting with new care models, such as the Triage-Treat-and-Release program at the Lutheran Medical Center (LMC) ED in New York, where physicians handle both phases of service for low-acuity patients. Our goal is to determine how physicians should prioritize triage versus treatment to balance initial delays with timely discharges. Triage and treatment are modeled as a two-phase stochastic service system, where patients may leave without receiving treatment. Patients leaving without receiving treatment increases the importance of the second phase. We introduce K-level threshold policies which prioritize treatment unless there are K or more patients in triage. The effect is a class of policies that capture a decision-maker’s valuation of the importance of each activity; lower K values signifies triage priority. Sufficient conditions are provided to ensure these policies yield a stable system. A heuristic is presented for choosing K. Using LMC data, K-level threshold policies, compared to other practical policies, perform well with respect to average rewards and waiting times over a range of parameters. These policies promise physicians an effective and simple way to allocate their time between triage and treatment.