Use of an Administrative Data Set to Determine Optimal Scheduling of an Alcohol Intervention Worker

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• 作者：Timothy A. Peterson ; MD ; Jeffrey S. Desmond ; MD ; Rebecca Cunningham ; MD
• 关键词：manpower ; organization & administration ; prevention & control ; utilization
• 刊名：Journal of Emergency Medicine
• 出版年：2012
• 出版时间：June, 2012
• 年：2012
• 卷：42
• 期：6
• 页码：712-718
• 全文大小：323 K

文摘

Background

Brief alcohol interventions are efficacious in reducing alcohol-related consequences among emergency department (ED) patients. Use of non-clinical staff may increase alcohol screening and intervention; however, optimal scheduling of an alcohol intervention worker (AIW) is unknown.

Objectives

Determine optimal scheduling of an AIW based on peak discharge time of alcohol-related ED visits.

Methods

Discharge times for consecutive patients with an alcohol-related diagnosis were abstracted from an urban ED¡¯s administrative data set from September 2005 through August 2007. Queuing theory was used to identify optimal scheduling. Data for weekends and weekdays were analyzed separately. Stationary independent period-by-period analysis was performed for hourly periods. An M/M/s queuing model, for Markovian inter-arrival time/Markovian service time/and potentially more than one server, was developed for each hour assuming: 1) a single unlimited queue; 2) 75 % of patients waited no longer than 30 min for intervention; 3) AIW spent an average 20 min/patient. Estimated average utilization/hour was calculated; if utilization/hour exceeded 25 % , AIW staff was considered necessary.

Results

There were 2282 patient visits (mean age 38 years, range 11-84 years). Weekdays accounted for 45 % of visits; weekends 55 % . On weekdays, one AIW from 6:00 a.m.-9:00 a.m. (max utilization 42 % /hour) would accommodate 28 % of weekday alcohol-related patients. On weekends, 5:00 a.m.-11:00 a.m. (max utilization 50 % ), one AIW would cover 54 % of all weekend alcohol-related visits. During other hours the utilization rate falls below 25 % /hour.

Conclusions

Evaluating 2 years of discharge data revealed that 30 h of dedicated AIW time?8 weekend hours (5:00 a.m.-11:00 a.m.), 12 weekday hours (6:00 a.m.-9:00 a.m.)¡ªwould allow maximal patient alcohol screening and intervention with minimal additional burden to clinical staff.