A Markov chain approach to study flow disruptions on surgery in emergency care

The work flow of surgical operations in emergency department can be interrupted due to various disruptions. Reducing such disruptions is of significant importance to ensure successful operations. In this paper, we introduce a continuous time Markov chain model to analyze the disruptions and their impacts. Analytical formulas have been derived to evaluate the probabilities of normal operations and disruptions. A continuous improvement method has been developed to identify the disruption that impedes surgical operation in the strongest manner. Such a disruption is referred to as the bottleneck disruption (BN-d). Reducing the interruption time of the BNd can lead to the largest improvement in normal operation. An application of the method at an emergency department of a large academic medical center is presented to illustrate the effectiveness of the model and the improvement approach. It is discovered that the disruption due to coordination problem is the system bottleneck.