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Open Access

Analyzing supply and demand on a general internal medicine ward: a cross-sectional study

Michael Fralick, Neal Kaw, Mingkun Wang, Muhammad Mamdani and Ophyr Mourad
November 16, 2021 9 (4) E1021-E1025; DOI: https://doi.org/10.9778/cmajo.20200252
Michael Fralick
Sinai Health System and the Department of Medicine (Fralick), University of Toronto; Li Ka Shing Centre for Healthcare Analytics Research and Training (Fralick, Kaw, Wang, Mamdani), St. Michael’s Hospital, Toronto, Ont.; Operations Research Center (Kaw), Massachusetts Institute of Technology, Cambridge, Mass.; Unity Health (Mourad), Department of Medicine, University of Toronto, Toronto, Ont.
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Neal Kaw
Sinai Health System and the Department of Medicine (Fralick), University of Toronto; Li Ka Shing Centre for Healthcare Analytics Research and Training (Fralick, Kaw, Wang, Mamdani), St. Michael’s Hospital, Toronto, Ont.; Operations Research Center (Kaw), Massachusetts Institute of Technology, Cambridge, Mass.; Unity Health (Mourad), Department of Medicine, University of Toronto, Toronto, Ont.
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Mingkun Wang
Sinai Health System and the Department of Medicine (Fralick), University of Toronto; Li Ka Shing Centre for Healthcare Analytics Research and Training (Fralick, Kaw, Wang, Mamdani), St. Michael’s Hospital, Toronto, Ont.; Operations Research Center (Kaw), Massachusetts Institute of Technology, Cambridge, Mass.; Unity Health (Mourad), Department of Medicine, University of Toronto, Toronto, Ont.
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Muhammad Mamdani
Sinai Health System and the Department of Medicine (Fralick), University of Toronto; Li Ka Shing Centre for Healthcare Analytics Research and Training (Fralick, Kaw, Wang, Mamdani), St. Michael’s Hospital, Toronto, Ont.; Operations Research Center (Kaw), Massachusetts Institute of Technology, Cambridge, Mass.; Unity Health (Mourad), Department of Medicine, University of Toronto, Toronto, Ont.
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Ophyr Mourad
Sinai Health System and the Department of Medicine (Fralick), University of Toronto; Li Ka Shing Centre for Healthcare Analytics Research and Training (Fralick, Kaw, Wang, Mamdani), St. Michael’s Hospital, Toronto, Ont.; Operations Research Center (Kaw), Massachusetts Institute of Technology, Cambridge, Mass.; Unity Health (Mourad), Department of Medicine, University of Toronto, Toronto, Ont.
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    Figure 1:

    (A) Distribution of 8 am census in general internal medicine inpatient service, by month (data from January 2016 to December 2018). (B) Median census by hour of day and day of week. Data ranged from January 2016 to February 2019, Sunday to Saturday, excluding holidays. (C) Distribution of daily frequency of internal medicine consults. Data spans from January 2016 to December 2018. (D) Frequency of emergency department consults by hour of request (actual or imputed). Data ranged from January 2016 to December 2018. Note: For the census and emergency department consults data, box-whisker plot is used to show an indication of how the census (or consult frequency) volumes are spread out. The lower and upper bounds of the box represent, respectively, the 25th percentile and the 75th percentile of the volume of census (or consult frequency), and the horizontal line inside the box represents the median of the data. The range that the box covers (25th percentile to 75th percentile) is defined as interquartile range (IQR), and the lower and upper ends of the whiskers represent the “minimum” (i.e., 25th percentile – 1.5*IQR) and “maximum” (i.e., 75th percentile + 1.5*IQR) observation in the sample, respectively. The black dots are outliers.

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    Figure 2:

    Resident utilization whereby each panel in the utilization histogram contains 52 data points representing the 52 weeks of the year. The red dashed line marks 100% utilization. (A) Weekday utilization scenario 1. This scenario assumed all residents were present apart from those who were post-call. (B) Weekday utilization scenario 2. This scenario assumed 1 resident was away on vacation each week and also accounted for a resident being post-call. (C) Weekday utilization scenario 3. This scenario assumed 1 resident was away on vacation and another resident was away sick, and also accounted for a resident being post-call. (D) Weekend utilization across all scenarios.

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CMAJ Open: 9 (4)
Vol. 9, Issue 4
1 Oct 2021
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Analyzing supply and demand on a general internal medicine ward: a cross-sectional study
Michael Fralick, Neal Kaw, Mingkun Wang, Muhammad Mamdani, Ophyr Mourad
Oct 2021, 9 (4) E1021-E1025; DOI: 10.9778/cmajo.20200252

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Analyzing supply and demand on a general internal medicine ward: a cross-sectional study
Michael Fralick, Neal Kaw, Mingkun Wang, Muhammad Mamdani, Ophyr Mourad
Oct 2021, 9 (4) E1021-E1025; DOI: 10.9778/cmajo.20200252
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