The Effects of Discrete Work Shifts on a Nonterminating Service System

Hospital emergency departments (EDs) provide around-the-clock medical care, and as such are generally modeled as nonterminating queues. However, from the care provider's point of view, ED care is not a never-ending process, but rather occurs in discrete work shifts and may require passing unfinished work to the next care provider at the end of the shift. We use data from a large, academic medical center ED to show that the patients' rate of service completion varies over the course of the physician shift. Furthermore, patients that have experienced a physician handoff have a higher rate of service completion than nonhanded off patients. As a result, a patient's expected treatment time is impacted by when the physician's shift treatment begins. We also show that patients that have been handed off are more likely to revisit the ED within three days, suggesting that patient handoffs lower clinical quality. Lastly, we use simulation to show that shift length and new-patient cutoff rules can be used to reduce handoffs, but at the expense of system throughput.