3.

Process Flow Measures

A1. ER1; Problem 3.4 MBPF

1

A hospital emergency room (ER) is currently organized

so that all patients register through an initial check-in
process. Each patient is seen by a doctor and then
exits the process, either with a prescription or with
admission to the hospital.
55 patients per hour arrive at the ER, 10% are
admitted to the hospital and the rest will leave with a
simple prescription.
On average, 7 people are waiting to be registered and
34 are registered and waiting to see a doctor.
The registration process takes, on average, 2 minutes
per patient. Among patients who receive prescriptions,
average time spent with a doctor is 5 minutes. Among
those admitted to the hospital, average time is 30
minutes.
 3. Process Flow Measures

A1. Directions
2

o) Draw the flow process chart

b) On average how long a patient spend in ER?
c) On average how many patients are in ER?
Hints:
Compute flow time in buffer 1
Compute average activity time of Doctor
Compute the average flow time in this process
Compute average flow time for a simple prescription
patient
Compute average flow time for a potential
admission patient
Compute number of patients in Doctor activity
Compute the average number of patients in the
process.
 3. Process Flow Measures

A1. Flow Time

3
Potential admits
10%
Buffer 1 Registration Buffer 2 Doctor
R =55/hr
I=7 I = 34
T = 2 min T1 = 5min 90%
T2 = 30min
Simple Prescription
R I T
Buffer 1 55 7 7.6
Registeration 55 2
Buffer 2 55 34 37.1
Doctor 55 7.5
TD= 0.9(5)+0.1(30) = 7
54.2
Re-Check

TPA= 7.6+2+37.1+30 = 76.7

TSP= 7.6+2+37.1+5 = 51.7 TP= 0.1(76.7)+0.9(51.7) = 54.2
 3. Process Flow Measures

A1. Inventory
4

Potential admits
10%
Buffer 1 Registration Buffer 2 Doctor
R =55/hr
I=7 I = 34
T = 2 min T1 = 5min 90%
T2 = 30min
Simple Prescription

R I T
Buffer 1 55 7 7.6
Registeration 55 1.8 2
Buffer 2 55 34 37.1
Doctor 55 6.9 7.5
54.2
 3. Process Flow Measures

A1. The Little’s Law

5
Potential admits
10%
Buffer 1 Registration Buffer 2 Doctor
R =55/hr
I=7 I = 34
T = 2 min T1 = 5min 90%
T2 = 30min
R I T Simple Prescription

Buffer 1 55 7 7.6
Registeration 55 1.8 2
Buffer 2 55 34 37.1
Doctor 55 6.9 7.5
49.7 54.2

Recheck I = 49.7, R = 55. Is our T= 54.2 correct?

RT= I
R = 55/60 = 0.916667 minutes
RT = I  T=I/R = 49.7/0.916667 = 54.2
 3. Process Flow Measures

A2. ER2; Problem 3.5 MBPF

6

A triage system has been proposed for the ER described in

Exercise 3.4. As mentioned earlier, 55 patients per hour
arrive at the ER. Patients will be registered as before and it
takes an average of 2 minutes per patient. They will then be
quickly examined by a nurse practitioner who will classify
them as Simple Prescriptions or Potential Admits. Planners
anticipate that the initial examination by triage nurses will
take 3 minutes. They expect that, on average, 20 patients
will be waiting to register and 5 will be waiting to be seen by
the triage nurse. Planners expect eh Simple Prescriptions
area to have, on average, 15 patients waiting to be seen. As
before, once a patient’s turn come, each will take 5 minutes
of a doctor’s time. The hospital anticipates that, on average,
the emergency area will have only 1 patient waiting to be
seen . As before, once that patient’s turn comes, he or she
will take 30 minutes of a doctor’s time. Assume that, as
 3. Process Flow Measures

A2. Directions
7

o) Draw the flow process chart

a) On average how many patients are in ER?
b) On average, how long a patient spend in ER?
c) Compute average flow rate in buffer 3 and buffer
4.
d) Compute average flow time in all buffers.
e) Compute average number of patients in all
activities.
f) On average, how long does a simple prescription
patient spend in the ER?
d) On average, how long does a Potential Admit
patient spend in the ER?
 3. Process Flow Measures

A2. Process Flow and TR=I Table

8

Buffer 3 Potential admits

5.5/hr
Buffer 1 Registration Buffer 2 Triage Nurse
55/hr

49.5/h
r Buffer 4 Simple Prescription

R R/min I T
Buffer 1 55 0.916667 20
Registeration 55 0.916667 2
Buffer 2 55 0.916667 5
Triage Nurse 55 0.916667 3
Buffer 3 5.5 0.091667 1
Potential Admission 5.5 0.091667 30
Buffer 4 49.5 0.825 15
Simple Prescription 49.5 0.825 5
 3. Process Flow Measures

A2. Inventory and Flow Time; Macro

Method 9

R R/min I T
Buffer 1 55 0.916667 20 21.8
Registeration 55 0.916667 1.8 2
Buffer 2 55 0.916667 5 5.5
Triage Nurse 55 0.916667 2.8 3
Buffer 3 5.5 0.091667 1 10.9
Potential Admission 5.5 0.091667 2.8 30
Buffer 4 49.5 0.825 15 18.2
Simple Prescription 49.5 0.825 4.1 5
a) On average, how many patients are in ER?I = 52.5
ER
b) On average, how long will a patient spend in ER?
Method 1: Macro Method, a single flow unit
RER= 55/60 flow units / min , IER= 52.5

TER = 52.5/(55/60) = 57.2

 3. Process Flow Measures

A2. Flow Time; Micro Method

10
R R/min I T
Buffer 1 55 0.916667 20 21.8
Registeration 55 0.916667 1.8 2.0
Buffer 2 55 0.916667 5 5.5
Triage Nurse 55 0.916667 2.8 3.0
Buffer 3 5.5 0.091667 1 10.9
Potential Admission 5.5 0.091667 2.8 30.0
Buffer 4 49.5 0.825 15 18.2
Simple Prescription 49.5 0.825 4.1 5.0

Method 2: Micro Method, two flow units, Potential Admission and Simple
Prescription
TPA= 21.8+2+5.5+3+10.9 +30 = 73.2
TSP= 21.8+2+5.5+3+18.2 +5 = 55.5

) OnTER= .1(73.2)+.9(55.5)
average, how long will a potential= 57.3 patient spend in ER?
admission 73.
 3. Process Flow Measures

A3. ER3; Problem 3.6 MBPF

11

Refer again to Exercise 3.5. Once the triage system is

put in place, it performs quite close to expectations. All
data conform to planners’ expectations except for one
set-the classifications made by the nurse practitioner.
Assume that the triage nurse has been sending 91% of
all patients to the Simple Prescription area when in fact
only 90% should have been so classified. The remaining
1% is discovered when transferred to the emergency
area by a doctor. Assume all other information from
Exercise 3.5 to be valid.
 3. Process Flow Measures

A3. Directions
12

o) Draw the flow process chart

a) On average how many patients are in ER?
b) On average, how long a patient spend in ER?
c) Compute average flow rate in buffer 3 and buffer 4.
d) Compute average flow time in all buffers.
e) Compute average number of patients in all
activities.
f) On average, how long does a simple prescription
patient spend in the ER?
d) On average, how long does a Potential Admit patient
spend in the ER?
 3. Process Flow Measures
Problem 3.6
A3. Process Flow and Throughputs
13
Buffer 3 Potential admits
4.95/hr
Buffer 1 Registration Buffer 2 Triage Nurse
55/hr
0.55/hr

50.05/h
r Buffer 4 Simple Prescription

R R/min I T
Buffer 1 55 0.916667 20
Registeration 55 0.916667 2
Buffer 2 55 0.916667 5
Triage Nurse 55 0.916667 3
Buffer 3 5.5 0.091667 1
Potential Admission 5.5 0.091667 30
Buffer 4 50.05 0.834167 15
Simple Prescription 50.05 0.834167 5
 3. Process Flow Measures

A3. Inventory and Flow Time; Macro

Method 14

R R/min I T
Buffer 1 55 0.916667 20 21.8
Registeration 55 0.916667 1.8 2
Buffer 2 55 0.916667 5 5.5
Triage Nurse 55 0.916667 2.8 3
Buffer 3 5.5 0.091667 1 10.9
Potential Admission 5.5 0.091667 2.8 30
Buffer 4 50.05 0.834167 15 18.0
Simple Prescription 50.05 0.834167 4.2 5
Macro: Average number of patients in the system =
20+1.8+5+2.8+1+2.8+15+4.2 = 52.6
Average flow time = I/R = 52.6/(55/60) = 57.3
 3. Process Flow Measures

A3. Flow Time; Simple Prescription

15

R R/min I T
Buffer 1 55 0.916667 20 21.8
Registeration 55 0.916667 1.8 2
Buffer 2 55 0.916667 5 5.5
Triage Nurse 55 0.916667 2.8 3
Buffer 3 5.5 0.091667 1 10.9
Potential Admission 5.5 0.091667 2.8 30
Buffer 4 50.05 0.834167 15 18.0
Simple Prescription 50.05 0.834167 4.2 5

Micro Method Compute SP and PA first

TSP= 32.3+18+5 = 55.3
Common =
21.8 +2+5.5+3 = 32.3
 3. Process Flow Measures

A3. Flow Time; Potential Admission and

Overall 16
R R/min I T
Buffer 1 55 0.916667 20 21.8
Registeration 55 0.916667 1.8 2
Buffer 2 55 0.916667 5 5.5
Triage Nurse 55 0.916667 2.8 3
Buffer 3 5.5 0.091667 1 10.9
Potential Admission 5.5 0.091667 2.8 30
Buffer 4 50.05 0.834167 15 18
Simple Prescription 50.05 0.834167 4.2 5

0.0 Potential
9 Admissio
Common n
32.3 40.9
0.0
1
Simple
0.9 55.3 Prescripti
0.09 73.2 0.
on 9
0.01 96.2
23
 3. Process Flow Measures

A3. Flow Time; Potential Admission and

Overall 17
R R/min I T
Buffer 1 55 0.916667 20 21.8
Registeration 55 0.916667 1.8 2
Buffer 2 55 0.916667 5 5.5
Triage Nurse 55 0.916667 2.8 3
Buffer 3 5.5 0.091667 1 10.9
Potential Admission 5.5 0.091667 2.8 30
Buffer 4 50.05 0.834167 15 18
Simple Prescription 50.05 0.834167 4.2 5

TPA1= 32.3 +10.9+30 = 73.2 ……(4.95 PA patients out of 5.5 PA

patient: 90%)
TPA2= 73.2+18+5 = 96.2 (0.55 PA patients out of 5.5 PA patient:
10%)
TSP= 55.3 is 90% of flow units, and TPA =75.5 is for 10% of flow
TPA = 73.2(.9) + 96.2(.1) =75.5
units Rechec
T = 55.3 (.9) + 75.5(.1) = 57.32 k
T= 55.3 (0.9) + 73.2 (0.09) + 96.2 (0.01)
Recheck
T= 57.32
Again