A hospital's emergency room wait times have doubled in a year. How would you structure the problem?

Can I clarify what we're measuring? Is it the wait to see a doctor, or the total time in the ER? And did it climb gradually or jump at some point? A wait builds when patients arrive faster than the ER can move them through, so I'd look at three things. First, what's coming in. Are there more patients than a year ago, or sicker ones? I'd look at arrivals by hour and by severity. Second, capacity inside the ER. That's doctors, nurses and beds. I'd compare staffing with arrivals hour by hour. Third, what's going out. Patients who are done in the ER need somewhere to go. I'd check how long that takes. I'd time each step from the door to discharge and see which step grew. That should show where the bottleneck is. Is there data on patient volumes and timing?

Can I clarify what we're measuring? Is it the wait to see a doctor, or the total time in the ER? And did it climb gradually or jump at some point? I'll assume it's the time from arrival to seeing a doctor, up from 30 minutes to an hour, and that it rose steadily. A wait builds when patients arrive faster than the ER can move them through, so I'd look at three things. First, what's coming in. Are there more patients than a year ago, or sicker ones? I'd look at arrivals by hour and by severity. If a nearby urgent care closed, the ER could be absorbing minor cases, and the peak hours matter more than the daily average. Second, capacity inside the ER. That's doctors, nurses and beds. I'd compare staffing with arrivals hour by hour. I'd also check for vacancies, or more temporary staff than last year. Third, what's going out. Patients who are done in the ER need somewhere to go. I'd check how long that takes. This is the one people miss. If the hospital's inpatient beds are full, admitted patients sit in ER beds for hours waiting for a room, and that blocks everyone behind them. So the cause may be upstairs, in slow discharges on the wards. I'd time each step from the door to discharge and see which step grew. My hypothesis is that it's an exit problem, with admitted patients stuck waiting for beds, because patient volumes rarely jump enough in a year to double a wait. I'd ask for timestamps by stage and the number of admitted patients held in the ER. Do we have those?