R.V.

COLLEGE OF ENGINEERING, BENGALURU–560059

(Autonomous Institution Affiliated to VTU, Belagavi)

“APPLICATIONS OF PROBABILITY
(QUEUING THEORY) IN HEALTH
CARE”
PROJECT REPORT

Submitted by,

TUSHAR LAL – 1RV17CS174

Under the guidance of
Mr. S R Swamy
Assistant Professor,
Dept. of CSE,
R. V. College of Engineering.
in partial fulfilment for the award of degree
Of
Bachelor of Engineering
In
COMPUTER SCIENCE AND ENGINEERING
2019-2020
 R.V. COLLEGE OF ENGINEERING, BENGALURU–
560059
(Autonomous Institution Affiliated to VTU,
Belagavi)
DEPARTMENT OF COMPUTER SCIENCE AND ENGINEERING

CERTIFICATE

This is to Certify that the minor project work titled, “APPLICATIONS OF

PROBABILITY (QUEUING THEORY) IN HEALTH CARE”, carried out by
TUSHAR LA (1RV17CS174) in partial fulfilment for the award of the degree of
Bachelor of Engineering in Computer Science & Engineering of the Visvesvaraya
Technological University, Belagavi during the year 2019-2020. It is certified that all the
corrections/suggestions indicated for the internal assessment have been incorporated in
the report deposited in the department library. The project report has been approved as it
satisfies academic requirements in respect of project work prescribed by the institution
for the said degree.

Signature of Guide Signature of the Head of Dept.

Signature with Date:

ABSTRACT

Operational research embodies a wide range of techniques that can improve the way
we plan and organize health services. Operation research (O.R) focuses on the
application of analytical methods to facilitate better decision-making. This paper is
an attempt to analyze the theory (Queuing) and instances of use of queuing theory
in health care organizations around the world and benefits acquired from the same.
.

INTRODUCTION

Operation Research existed as a scientific discipline since 1930’s. It is a discipline of

applying appropriate analytical methods for decision making. OR has been studied in
health care settings since 1952. One of the major uses of operational research in
healthcare is in the form of Queuing theory. Queues or Queuing theory was first
analysed by A.K Erlang in 1913 in the context of telephone facilities. It is extensively
practiced or utilized in industrial setting or retail sector-operations management, and
falls under the purview of decision Sciences. The rising cost of health care can be
attributed not only to ageing population and new expensive and advanced treatment
modalities but also to inefficiencies in health delivery. Queuing theory application is an
attempt to minimize the cost through minimization of inefficiencies and delays in the
system. There are many problems in health care system which can be solved using
queuing theory in operational research. Few of them are discussed below: Long
waiting time at outpatient clinics before consultation Patients need to make an
appointment for a specialist. An appointment system reduces patient waiting time. A
Good appointment Schedule is one that trade-offs patients waiting time for clinics
overtime, constrained by patient load and staffing. Using O.R we can use techniques
such as queuing theory and discrete event simulation to propose various appointment
strategies under different clinics settings.

HEALTH SERVICE CAPACITY PLANNING

It is common for health care managers to project workload for physical infrastructure
and manpower planning. This may be done at different departments, hospitals or even
national level. It is a common method to look at past trends, estimate the historical
year-on -year growth and extrapolate this growth rate to the future. However, there are
two potential problems. Firstly, we seldom see a definitive trend and the estimation of
“growth rate” is highly dependent upon the start and end points of time intervals.
Secondly, the assumption of a long-lasting trend is also unrealistic. A health care
utilization is often closely related to age, a more robust way to project is to use
population-based drivers. We can first drive the age specific utilization rate, which is
the number of encounters (E.g. emergency or patient attendances, hospital admissions)
as per population specific to each age group.
With rapid change and realignment of health care system, new lines of services and
facilities to render the same, server financial pressure on the health care organizations
and extensive use of expanded managerial skills in health care setting, use
of queuing models has become quite prevalent in it. Queuing models are
used to achieve a balance or trade-off between capacity and service delays.

For application of queuing models to any situation we should first describe the “Input
Process” and “output Process”. An Example is shown below with a brief description of
both process:

SETTING INPUT PROCESS OUTPUT PROCESS

HOSPITAL Arrival of the patient at Assessment, Triage,
the registration counter Provision of services,
discharge
PCP OFFICE Arrival at registration Assessment by PCP,
counter or front or front Prescription and tests,
office desk and collection of bills at
the exit
ER Ambulance arrival Assessment triage,
assessment, Triage to the
inpatient setting or
discharge after treatment

So why use the queuing theory in first place-the answer is to minimize total cost to the
system. These costs can be divided into two broad categories:

COSTS ASSOCIATED WITH PATIENTS OR CUSTOMERS

HAVING TO WAIT FOR THE SERVICE
＊ Loss of business to HCO, as some patients might not be willing to wait for the
service and may decide to go to the competing organizations.

＊ Costs incurred by society for example increased interventions and cost due to delay
in care or the value of patient’s time.

＊ Decreased patient satisfaction and quality of care.

COSTS OF PROVIDING THE SERVICE (CAPACITY COSTS)

＊ Salaries paid to employees.

＊ Salaries paid to employees or servers while they wait for service from other server,
for example waiting for the pathology report, radiology report, labs, etc.

＊ Fixed costs – cost of waiting space, facilities, equipment’s, and supplies. If the
organization decides to increase the level of service provided, cost of providing
services would increase, if it decides to limit the same, costs associated with waiting
for the services would increase. So, the manager has to balance the two costs and make
a decision about the provision of optimum level of service

QUEUING THEORY AND HEALTHCARE

The health systems should have an ability to deliver safe, efficient and smooth services
to the patients. Several key reimbursement changes, increasing critiques and cost
pressures on the system and increasing demand of quality and efficacy from highly
aware and educated patients due to advances in technology and telecommunications
have started putting more pressure on the healthcare managers to respond to these
concerns. Queuing theory is an example of the use in healthcare. It essentially deals
with patient flow through the system, if patient flow is good then patient queuing is
minimized, if it is bad then the system may suffer loss of business and patients may
suffer considerable queuing delays. Health care system can be visualized as a complex
queuing network in which delays can be reduced through the following ways:
。 Synchronization of work among service stages (e.g., coordination of tests,
treatments, discharge processes)
。 Scheduling of resources (e.g., doctors and nurses) to match patterns of arrival
。 Constant system monitoring (e.g., tracking number of patients waiting by location,
diagnostic grouping and acuity) linked to immediate actions. Queuing theory is now
fairly extensively used in the following settings:

EMERGENCY ROOM ARRIVALS

This is one of the areas where most of the research and applications of queuing theory
have been done. Closure of several ED (Emergency Departments) in last few years and
significant variation in ED patient arrival rates have leaded to increased crowding and
prolonged waiting times. Many of the patients even leave to seek services at a different
place. Gravity of the situation can be appreciated by reading the following real-life
instance given below: “A teenage girl was hit in the mouth playing softball, causing
injury to her teeth. She arrived in the emergency department, which was full, at 6 pm
and in a waiting room, holding a cloth to her face, bleeding for 2 hours. Finally, when a
bed opened for her, the doctor saw she had significant dental injuries, including loose
upper front teeth. He ordered an x-ray. Once he had the results several hours later, he
called an orthodontist who fortunately agreed to see her right away. By then, it was 12
midnight.” The major goal of queuing theory application in such a scenario is analysis
of the arrival patterns of the patients over time to a particular ED or an area (city, state,
and nation) and using the findings for appropriate staffing and facilities design. Several
studies have been done in this field and they all show promising results. A study done
by Green, et al, examined the effectiveness of a queuing model in identifying provider
staffing patterns to reduce the fraction of patients who leave without being seen and
their conclusion was that queuing models can be extremely useful in most effective
allocation of staff.

-Walk in patients in physician offices, outpatient clinics and outpatient surgeries in

hospitals

The management of healthcare facilities such as outpatient clinics is very complex and
demanding to manage. The most common objectives of studies on the clinics have
included the reduction of patient’s time in the system (outpatient clinic), improvement
on customer service, better resource utilization, and reduction of operating costs.

Analysis in such cases involves, in depth analysis of the patient’s arrival and flow,
structure of the system, manpower characteristics and the scheduling system.
Appropriate queuing models are then developed and applied for process modifications,
appropriate staffing, scheduling or facility changes. Queuing theory can also be applied
to hospital settings, particularly outpatient clinics and surgeries. For example, small
surgeries are performed by interns or assisting staff members in a hospital and the
complicated ones by the experienced surgeons or a team. The experienced surgeons or
team members for support services arrive later during the day. But the interns start
their work earlier then the experienced surgeons. Using queuing theory in such a case,
we can determine the arrival patterns of patients or the service rate and time and
appropriately schedule surgeries for better quality and efficiency.

- Hospital Pharmacy and Pharmacy stores

The instances of application of queuing theory in pharmacy practice are very few.

Numerous pharmacies in the department of defence use automated Queuing

Technology (AQT). AQT is also utilized by many other big hospital systems with
significant caseloads, such as University of Virginia hospital systems. In Pharmacy,
Queuing theory can be used to assess a multitude of factors such as prescription fill
time, patient waiting time, patient counselling-time and staffing levels. The application
of queuing theory may be of particular benefit in pharmacies with high volume
outpatient workloads and/or those that provide multiple points of service. By better
understanding queuing theory, service managers can make decisions that increase the
satisfaction of all relevant groups-Customers, Employees and management o Health
care resource and infrastructure planning for disaster management Any type of disaster
cause significant human and economic damage and they all demand a crisis response.
It demands immediate rescue of people, provision of medical services needed and
containment of the damage to people and property. In such scenarios, queuing models
are frequently used in conjunction with simulation to answer the “what-if” questions,
to plan, organize and be prepared for the calamities. For Example, if H5N1 bird flu
spreads to US and causes an epidemic, it would be major crisis situation. Policy makers
and administrators are aware of this scenario and they use Queuing and simulation to
plan for such activities. It gives them data regarding, how many people and in what
locations would be affected, speed of disease spread, number and characteristics of
healthcare workers needed, pharmaceutical supplies, vaccines, number of beds and so
on.

- Public health Queuing models can also be used for public health.

For example, the resources needed for Mass vaccination camp in a particular area,
facility and resource planning for emerging or Changing disease profiles or changing
demographics.
LIMITATIONS OF QUEUING MODELS
As discussed at several places earlier, queuing models have several limitations and are Used in
conjunction with the other decision analysis methods like simulation and regression. Most of
these limitations are the basic assumptions for application of queuing models. Some of the
limitations of queuing models are enumerated below: o Takes average of all variables rather
than the real numbers itself. o Assumes steady state. o Based on assumption that service time is
known. Service times are independent from one another.o Service rate is known. o Service
rate is greater than arrival rate. o Service time is described by negative exponential probability
distribution.

CONCLUSION
Queuing theory, is “The mathematical approach to the analysis of waiting lines in
Health care setting”. Its use has been validated in industrial setting, retail sector and in-
service settings such as telecommunications but its adoption and use in healthcare
setting is lagging behind other sectors. In health sector it is mainly used in ED wait line
and staffing studies, analysis of queues in outpatient and ambulatory care settings and
for disaster management. However, it has scope for uses in any setting where there
exist wait lines or there is the potential for the same. It can be used in inpatient,
outpatient, Physician office, public health, facility and resource planning, emergency
preparedness, mental health, long term care, pharmacy, inventory control as well as
public health. However queuing models have several limitations, many of which are
based on its assumptions. The limitations of the queuing models can be offset partially
if they are used in conjunction with other decision analysis methods such as simulation
and regression. With the increasing cost pressure, changing reimbursement
mechanisms and affiliations, pressure for quality control, and awareness and demands
of the patients, sooner or later we will have to tap into the benefits of engineering
techniques such as queuing theory top provide smooth, safe and efficient healthcare
services to our customers, internal and external customer satisfaction and for
optimization of resources.

REFERENCES

1) Singh Vikas, Use of Queuing Models in Health Care (2006), University of Arkansas
for Medical Sciences

2) Au-Yeung, S.W.M., Harrison, P.G., & Knottenbelt, W.J., (2006), A queuing

network model of patient flow in an accident and emergency department, Department
of Computing, Imperial College of London, August 15, 2006.

3) Bevan, G., (1998), “Taking equity seriously: A dilemma for government from
allocating resources to primary care groups”, British Medical Journal 1998; 316:39-42.

4) Blum, F.C., (2006), Improving emergency medical care, Statement before Senate
Committee of Health, Education, Lab or and Pensions, Subcommittee on Bioterrorism
and Public Health Preparedness, 2006.
5) Bretthauer, K.M. & Cote, M.J., (1998), “A model for planning resource
requirements in health care organizations”, Accessed in November 2006 at
http://www.findarticles.com/p/articles/mi_qa3713/is_199801/ai_n8759291

6) Jr., R.N.A., & Wilson, J.P., (2001), Queuing theory and customer satisfaction: A
review of terminology, trends and applications to pharmacy practice, Hospital
Pharmacy, Volume 36, Number 3, 2001.

7) Kennedy, J., Rhodes, K., Walls, C.A., & Asplin, B.R., (2004), Access to emergency
care: restricted by long waiting times and cost and coverage concerns, Annals of
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