Assessment of patient-physician assignment criteria in emergency department by using discret-event-simulation

Physician's workload inequality in Emergency Departments (ED) is a relevant problem that affects their stress level, which influences the service quality and working conditions. The patient-physician assignment rule (PPAR) has a bearing on the physicians' workload, which has been studied in the Medical literature by performing interventions. These show that, contrary to basic models of queuing theory, automatic assignment of patients to physicians at triage (multiple queues model) reduces patient length of stay compared to self-assignment of patients by physicians (single queue allocation). Rotational PPAR facilitates the triage nurses' decision making and ensures an equal distribution of the number of patients, but it may not offset the differences in patients' severity and care needs, which lead to physicians' workload imbalance. Thus, such a problem has been addressed in a Spanish ED by developing a discrete-event- simulation model to assess different PPARs optimizing both criteria, patient's waiting time and physician's workload variability.