Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week

Olcay Özen; İlker Köse; Pakize Yıgıt; Şeyma Güner; Sabahattin Aydın

doi:10.37989/gumussagbil.1225744

Araştırma Makalesi

Türk Hastanelerinde Sistem Yönetimi Açısından Yoğunluk ve Hasta Bekleme Sürelerinin Analizi: Haftanın Gün Ve Saatlerine Göre Model Oluşturma

Yıl 2024, Cilt: 13 Sayı: 1, 441 - 452, 27.03.2024

Olcay Özen İlker Köse Pakize Yıgıt Şeyma Güner Sabahattin Aydın

https://doi.org/10.37989/gumussagbil.1225744

Öz

Bekleme sırasında geçirilen zaman hasta memnuniyeti ve hastane verimliliği açısından önemli bir sorun oluşturmaktadır ve yönetimin çözüme yönelik karar alabilmesi için kanıta dayalı bilgiye duyduğu ihtiyacı artırmaktadır. Bu çalışma, daha iyi bir hizmet sunum sistemi tasarlamak için hastanelerdeki süreç akışlarını gerçek veriler üzerinden inceleyerek, süreçteki yoğunlukların tespit edilmesi ve gerekli iyileştirmelerin planlanması açısından bir model oluşturmayı amaçlamaktadır. Bu amaç için, Türkiye’de 2. ve 3. basamak sağlık kurumlarına ait ulusal randevu sistemi (MHRS) üzerinde depolanan 2016 yılına ait veri setleri incelenmiştir. Veriler; veri ön işleme, temizleme ve dönüştürme aşamalarından geçirilerek analiz edilmiştir. Hastanelerdeki gün ve saatlere göre yoğunluk örüntüleri tespit edilmiştir. Türkiye’deki hastanelerde pazartesi gününün, hasta yoğunluğunun en fazla olduğu ve en uzun bekleme süresine sahip olan gün olduğu görülmüştür. Bunun yanında, mesai saatlerine göre analiz edildiğinde, sabah ilk 2 saat (9.00-11.00) en fazla hastanın muayene edildiği dönem olduğu tespit edilmiştir. Öğle saati (12.00-13.00 arası) ve öğleden sonra saat 16.00-17.00 arası ise hasta frekansının en düşük, ancak ortalama bekleme süresinin en uzun olduğu zamanlardır. Çalışma sonuçlarına göre, Türkiye’deki hastanelerde hasta bekleme sürelerinin özellikle bazı gün ve saatlerde yoğun olduğu tespit edilmiştir. Böylece genel bir planlama önerisinden ziyade yoğunluk örüntülerinin tespit edildiği gün ve saatler özelinde politika önerileri geliştirilebilir. Bu çalışma, süreç verileri üzerinden Türkiye'de yapılan en kapsamlı çalışmadır. Çalışma modeli farklı ülke ve bölgelerde tekrarlanabilir niteliktedir.

Anahtar Kelimeler

Hasta Bekleme Süreleri, Sağlık Hizmetleri Planlaması, Sağlık Bilişimi, Sağlık Yönetimi, Sağlık Politikası

Kaynakça

1. Au, J, Horwood, C, Hakendorf, P. and Thompson, C. (2019). ‘‘Similar Outcomes for General Medicine Patients Discharged on any day of the week’’. Internal Medicine Journal, 49 (3), 380–384. https://doi.org/10.1111/imj.14083
2. Brandenburg, L, Gabow, P. and Steele, G. (2015). ‘‘Innovation and Best Practices in Health Care Scheduling’’. NAM Perspectives.
3. British Columbia Medical Association (2006). ‘‘Waiting Too Long: Reducing And Better Managing Wait Times. By The BCMA’s Council On Health Economics & Policy’’. British Columbia Medical Association.
4. Budinoski, K., and Trajkovik, V. (2012). ‘‘Incorporate Social Network Services In E-Government Solutions: The Case Of Macedonia’’. International Journal of EBusiness and EGovernment Studies, 1 (4), 23–35. https://doi.org/10.17226/20220
5. Cantwell, K., Morgans, A., Smith, K., Livingston, M., Spelman, T. and Dietze, P. (2015). ‘‘Time of Day and Day of Week Trends in EMS Demand’’. Prehospital Emergency Care, 19 (3), 425–431. https://doi.org/10.3109/10903127.2014.995843
6. Edgar Elías Osuna. (1985). ‘‘The Psychological Cost Of Waiting’’. Journal of Mathematical Psychology, 29 (1), 82–105. https://doi.org/https://doi.org/10.1016/0022-2496(85)90020-3
7. Fieldston, E. S., Hall, M., Shah, S. S., Hain, P. D., Sills, M. R., Slonim, A. D., Myers, A. L., Cannon, C. and Pati, S. (2011). ‘‘Addressing Inpatient Crowding By Smoothing Occupancy At Children’s Hospitals.’’ Journal of Hospital Medicine, 6 (8), 462–468. https://doi.org/10.1002/jhm.904
8. García, M. and Harmsen, B. (2012). ‘‘QlikView 11 for Developers’’. Packt Publishing Ltd.
9. Guttmann, A., Schull, M. J., Vermeulen, M. J. and Stukel, T. A. (2011). ‘‘Association Between Waiting Times And Short Term Mortality And Hospital Admission After Departure From Emergency Department: Population Based Cohort Study From Ontario, Canada’’. BMJ, 342(7809). https://doi.org/10.1136/bmj.d2983
10. Hong, T. S., Shang, P. P., Arumugam, M. and Yussuf, R. M. (2013). ‘‘Use of Simulation To Solve Outpatient Clinic Problems: a Review of the Literature.’’ South African Journal of Industrial Engineering, 24 (3), 27–42.
11. Johnson, W. L. and Rosenfeld, L. S. (1968). ‘‘Factors Affecting Waiting Time in Ambulatory Care Services.’’ Health Services Research, 3 (4), 286–295.
12. Kocas, C. (2015). ‘‘An Extension Of Osuna’s Model To Observable Queues’’. Journal of Mathematical Psychology, 66, 53–58.
13. Kreindler, S. A. (2008). ‘‘Watching Your Wait’’. Quality Management in Health Care, 17(2), 128–135. https://doi.org/10.1097/01.QMH.0000316990.48673.9f
14. Kreindler, S. A. (2010). ‘‘Policy Strategies To Reduce Waits For Elective Care: A Synthesis Of International Evidence’’. British Medical Bulletin, 95 (1), 7–32. https://doi.org/10.1093/bmb/ldq014
15. Küçük, A., Demirci, M., Kerman, G. and Özsoy, V. S. (2021). ‘‘Evaluating Of Hospital Appointment Systems In Turkey: Challenges And Opportunities’’. Health Policy and Technology, 10 (1), 69–74. https://doi.org/10.1016/j.hlpt.2020.11.008
16. Leddy, K. M., Kaldenberg, D. O. and Becker, B. W. (2003). ‘‘Timeliness In Ambulatory Care Treatment: An Examination Of Patient Satisfaction And Wait Times In Medical Practices And Outpatient Test And Treatment Facilities’’. The Journal of Ambulatory Care Management, 26 (2), 138–149. https://doi.org/10.1097/00004479-200304000-00006
17. Leiba, A., Weiss, Y., Carroll, J. S., Benedek, P. and Bar-dayan, Y. (2002). ‘‘Waiting Time İs A Major Predictor Of Patient Satisfaction in A Primary Military Clinic’’. Military Medicine, 167 (10), 842–845. https://doi.org/10.1093/milmed/167.10.842
18. Mazzocato, P., Savage, C., Brommels, M., Aronsson, H. and Thor, J. (2010). ‘‘Lean Thinking in Healthcare: A Realist Review Of The Literature’’. Quality and Safety in Health Care, 19 (5), 376-382.
19. Michael, M., Schaffer, S. D., Egan, P. L., Little, B. B. and Pritchard, P. S. (2013). “Improving Wait Times And Patient Satisfaction in Primary Care". Journal For Healthcare Quality, 35 (2), 50–60. https://doi.org/10.1111/jhq.12004
20. Oğuzlar, A. (2003). “Veri̇ Ön İ̇şleme”. Erciyes Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 21 (1), 67–76.
21. Potezny, T., Horwood, C., Hakendorf, P. and Thompson, C. (2018). “The Effect Of The Weekend Upon Admissions To General Medicine”. Journal of Evaluation in Clinical Practice, 24 (4), 726–730. https://doi.org/10.1111/jep.12953
22. Pyle, D. (1999). “Data Preparation for Data Mining” (D. D. Cerra, Ed.). Morgan Kaufmann.
23. Republic of Turkey Ministry of Health. (2016). “Republic of Turkey Ministry of Health Central Physician Appointment System”. Republic of Turkey Ministry of Health. https://www.hastanerandevu.gov.tr/Vatandas/hakkimizda.xhtml
24. Ryan, K., Levit, K. and Davis, P. (2006). “Characteristics of Weekday and Weekend Hospital Admissions: Statistical Brief”. In Healthcare Cost and Utilization Project (HCUP) Statistical Briefs.
25. Schoen, C. and Doty, M. M. (2004). “Inequities in Access To Medical Care in Five Countries: Findings from the 2001 Commonwealth Fund International Health Policy Survey”. Health Policy, 67 (3), 309–322. https://doi.org/10.1016/j.healthpol.2003.09.006
26. Şengül, Ü., Eslemian, S. and Eren, M. (2013). “Türkiye’de İstatistiki Bölge Birimleri Sınıflamasına Göre Düzey 2 Bölgelerinin Ekonomik Etkinliklerinin DEA Yöntemi ile Belirlenmesi ve Tobit Model Uygulaması”. Yönetim Bilimleri Dergisi, 11(21), 75–99.
27. Siciliani, L., Moran, V. and Borowitz, M. (2014). “Measuring and Comparing Health Care Waiting Times in OECD Countries”. Health Policy, 118, Art. 67.
28. Speed, D., Bornstein, S., Kean, R., Bornstein, S. and Brien, S. O. (2016). “Reducing Wait Times for Outpatient Services in Newfoundland and Labrador”. Applied Health Research.
29. Sun, J., Lin, Q., Zhao, P., Zhang, Q., Xu, K., Chen, H., Hu, C. J., Stuntz, M., Li, H. and Liu, Y. (2017). “Reducing Waiting Time And Raising Outpatient Satisfaction In A Chinese Public Tertiary General Hospital-An Interrupted Time Series Study”. BMC Public Health, 17 (1), 1–11. https://doi.org/10.1186/s12889-017-4667-z
30. Thompson, D. A., Yarnold, P. R., Williams, D. R., Adams, S. L., Soremekun, O. A., Takayesu, J. K., Bohan, S. J., Mardiah, F. P. and Basri, M. H. (2013). “The Analysis of Appointment System to Reduce Outpatient Waiting Time at Indonesia’s Public Hospital”. Human Resource Management Research, 3 (6), 27–33. https://doi.org/10.5923/j.hrmr.20130301.06
31. TR Ministry of Health. (2010). “TR Ministry of Health Central Physician Appointment System”. Access Address: https://www.mhrs.gov.tr/Vatandas/hakkimizda.xhtml
32. Tsoi, L., Ip, S. and Poon, L. (2011). “Monday Syndrome: Using Statistical and Mathematical Models to Fine-Tune Services in an Emergency Department”. Hong Kong Journal of Emergency Medicine, 18 (3), 150–154. https://doi.org/10.1177/102490791101800304
33. Young, T. P and McClean, S. I. (2008). “A Critical Look at Lean Thinking in Healthcare”. Quality and Safety in Health Care, 17 (5), 382–386.

Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week

Yıl 2024, Cilt: 13 Sayı: 1, 441 - 452, 27.03.2024

Olcay Özen İlker Köse Pakize Yıgıt Şeyma Güner Sabahattin Aydın

https://doi.org/10.37989/gumussagbil.1225744

Öz

The time spent waiting is an important problem regarding patient satisfaction and hospital efficiency, and increases the need for evidence-based information for management to make decisions towards a solution. This study aims to examine the process flows in hospitals based on actual data with the intent to design a better service delivery system and set a pattern in terms of determining the congestion in the process and planning the necessary improvements. For this purpose, the data sets for 2016 pertaining to secondary and tertiary level hospitals in Turkey, which are stored in the central physician appointment system (CPAS), are investigated. The data is analyzed through pre-processing, cleaning and transformation stages. Congestion patterns are determined by days and hours spent in hospitals. Monday is found to be the day with the highest patient density and the longest wait time in Turkish hospitals. Additionally, when analyzed by working hours, it is determined that the first 2 hours in the morning (9.00 a.m. to 11.00 a.m.) is the period when most patentse are examined. The lunchtime (between 12.00 p.m. - 1.00 p.m.) and the afternoon from 4.00 p.m. to 5.00 p.m. are the times when patient density is the lowest, but average wait time is the longest. Turkish hospitals are found to be particularly congested on some days and during some hours regarding patient wait times. Thus, policy recommendations can be developed specifically to the days and times when congestion patterns are identified rather than suggesting a general policy. This study is the most comprehensive study conducted in Turkey through process data. The working model is reproducible in different countries and regions.

Anahtar Kelimeler

Patient Wait Times, Health Services Planning, Health Information, Healthcare Management, Health Policy

Kaynakça

1. Au, J, Horwood, C, Hakendorf, P. and Thompson, C. (2019). ‘‘Similar Outcomes for General Medicine Patients Discharged on any day of the week’’. Internal Medicine Journal, 49 (3), 380–384. https://doi.org/10.1111/imj.14083
2. Brandenburg, L, Gabow, P. and Steele, G. (2015). ‘‘Innovation and Best Practices in Health Care Scheduling’’. NAM Perspectives.
3. British Columbia Medical Association (2006). ‘‘Waiting Too Long: Reducing And Better Managing Wait Times. By The BCMA’s Council On Health Economics & Policy’’. British Columbia Medical Association.
4. Budinoski, K., and Trajkovik, V. (2012). ‘‘Incorporate Social Network Services In E-Government Solutions: The Case Of Macedonia’’. International Journal of EBusiness and EGovernment Studies, 1 (4), 23–35. https://doi.org/10.17226/20220
5. Cantwell, K., Morgans, A., Smith, K., Livingston, M., Spelman, T. and Dietze, P. (2015). ‘‘Time of Day and Day of Week Trends in EMS Demand’’. Prehospital Emergency Care, 19 (3), 425–431. https://doi.org/10.3109/10903127.2014.995843
6. Edgar Elías Osuna. (1985). ‘‘The Psychological Cost Of Waiting’’. Journal of Mathematical Psychology, 29 (1), 82–105. https://doi.org/https://doi.org/10.1016/0022-2496(85)90020-3
7. Fieldston, E. S., Hall, M., Shah, S. S., Hain, P. D., Sills, M. R., Slonim, A. D., Myers, A. L., Cannon, C. and Pati, S. (2011). ‘‘Addressing Inpatient Crowding By Smoothing Occupancy At Children’s Hospitals.’’ Journal of Hospital Medicine, 6 (8), 462–468. https://doi.org/10.1002/jhm.904
8. García, M. and Harmsen, B. (2012). ‘‘QlikView 11 for Developers’’. Packt Publishing Ltd.
9. Guttmann, A., Schull, M. J., Vermeulen, M. J. and Stukel, T. A. (2011). ‘‘Association Between Waiting Times And Short Term Mortality And Hospital Admission After Departure From Emergency Department: Population Based Cohort Study From Ontario, Canada’’. BMJ, 342(7809). https://doi.org/10.1136/bmj.d2983
10. Hong, T. S., Shang, P. P., Arumugam, M. and Yussuf, R. M. (2013). ‘‘Use of Simulation To Solve Outpatient Clinic Problems: a Review of the Literature.’’ South African Journal of Industrial Engineering, 24 (3), 27–42.
11. Johnson, W. L. and Rosenfeld, L. S. (1968). ‘‘Factors Affecting Waiting Time in Ambulatory Care Services.’’ Health Services Research, 3 (4), 286–295.
12. Kocas, C. (2015). ‘‘An Extension Of Osuna’s Model To Observable Queues’’. Journal of Mathematical Psychology, 66, 53–58.
13. Kreindler, S. A. (2008). ‘‘Watching Your Wait’’. Quality Management in Health Care, 17(2), 128–135. https://doi.org/10.1097/01.QMH.0000316990.48673.9f
14. Kreindler, S. A. (2010). ‘‘Policy Strategies To Reduce Waits For Elective Care: A Synthesis Of International Evidence’’. British Medical Bulletin, 95 (1), 7–32. https://doi.org/10.1093/bmb/ldq014
15. Küçük, A., Demirci, M., Kerman, G. and Özsoy, V. S. (2021). ‘‘Evaluating Of Hospital Appointment Systems In Turkey: Challenges And Opportunities’’. Health Policy and Technology, 10 (1), 69–74. https://doi.org/10.1016/j.hlpt.2020.11.008
16. Leddy, K. M., Kaldenberg, D. O. and Becker, B. W. (2003). ‘‘Timeliness In Ambulatory Care Treatment: An Examination Of Patient Satisfaction And Wait Times In Medical Practices And Outpatient Test And Treatment Facilities’’. The Journal of Ambulatory Care Management, 26 (2), 138–149. https://doi.org/10.1097/00004479-200304000-00006
17. Leiba, A., Weiss, Y., Carroll, J. S., Benedek, P. and Bar-dayan, Y. (2002). ‘‘Waiting Time İs A Major Predictor Of Patient Satisfaction in A Primary Military Clinic’’. Military Medicine, 167 (10), 842–845. https://doi.org/10.1093/milmed/167.10.842
18. Mazzocato, P., Savage, C., Brommels, M., Aronsson, H. and Thor, J. (2010). ‘‘Lean Thinking in Healthcare: A Realist Review Of The Literature’’. Quality and Safety in Health Care, 19 (5), 376-382.
19. Michael, M., Schaffer, S. D., Egan, P. L., Little, B. B. and Pritchard, P. S. (2013). “Improving Wait Times And Patient Satisfaction in Primary Care". Journal For Healthcare Quality, 35 (2), 50–60. https://doi.org/10.1111/jhq.12004
20. Oğuzlar, A. (2003). “Veri̇ Ön İ̇şleme”. Erciyes Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 21 (1), 67–76.
21. Potezny, T., Horwood, C., Hakendorf, P. and Thompson, C. (2018). “The Effect Of The Weekend Upon Admissions To General Medicine”. Journal of Evaluation in Clinical Practice, 24 (4), 726–730. https://doi.org/10.1111/jep.12953
22. Pyle, D. (1999). “Data Preparation for Data Mining” (D. D. Cerra, Ed.). Morgan Kaufmann.
23. Republic of Turkey Ministry of Health. (2016). “Republic of Turkey Ministry of Health Central Physician Appointment System”. Republic of Turkey Ministry of Health. https://www.hastanerandevu.gov.tr/Vatandas/hakkimizda.xhtml
24. Ryan, K., Levit, K. and Davis, P. (2006). “Characteristics of Weekday and Weekend Hospital Admissions: Statistical Brief”. In Healthcare Cost and Utilization Project (HCUP) Statistical Briefs.
25. Schoen, C. and Doty, M. M. (2004). “Inequities in Access To Medical Care in Five Countries: Findings from the 2001 Commonwealth Fund International Health Policy Survey”. Health Policy, 67 (3), 309–322. https://doi.org/10.1016/j.healthpol.2003.09.006
26. Şengül, Ü., Eslemian, S. and Eren, M. (2013). “Türkiye’de İstatistiki Bölge Birimleri Sınıflamasına Göre Düzey 2 Bölgelerinin Ekonomik Etkinliklerinin DEA Yöntemi ile Belirlenmesi ve Tobit Model Uygulaması”. Yönetim Bilimleri Dergisi, 11(21), 75–99.
27. Siciliani, L., Moran, V. and Borowitz, M. (2014). “Measuring and Comparing Health Care Waiting Times in OECD Countries”. Health Policy, 118, Art. 67.
28. Speed, D., Bornstein, S., Kean, R., Bornstein, S. and Brien, S. O. (2016). “Reducing Wait Times for Outpatient Services in Newfoundland and Labrador”. Applied Health Research.
29. Sun, J., Lin, Q., Zhao, P., Zhang, Q., Xu, K., Chen, H., Hu, C. J., Stuntz, M., Li, H. and Liu, Y. (2017). “Reducing Waiting Time And Raising Outpatient Satisfaction In A Chinese Public Tertiary General Hospital-An Interrupted Time Series Study”. BMC Public Health, 17 (1), 1–11. https://doi.org/10.1186/s12889-017-4667-z
30. Thompson, D. A., Yarnold, P. R., Williams, D. R., Adams, S. L., Soremekun, O. A., Takayesu, J. K., Bohan, S. J., Mardiah, F. P. and Basri, M. H. (2013). “The Analysis of Appointment System to Reduce Outpatient Waiting Time at Indonesia’s Public Hospital”. Human Resource Management Research, 3 (6), 27–33. https://doi.org/10.5923/j.hrmr.20130301.06
31. TR Ministry of Health. (2010). “TR Ministry of Health Central Physician Appointment System”. Access Address: https://www.mhrs.gov.tr/Vatandas/hakkimizda.xhtml
32. Tsoi, L., Ip, S. and Poon, L. (2011). “Monday Syndrome: Using Statistical and Mathematical Models to Fine-Tune Services in an Emergency Department”. Hong Kong Journal of Emergency Medicine, 18 (3), 150–154. https://doi.org/10.1177/102490791101800304
33. Young, T. P and McClean, S. I. (2008). “A Critical Look at Lean Thinking in Healthcare”. Quality and Safety in Health Care, 17 (5), 382–386.

Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	İngilizce
Konular	Sağlık Kurumları Yönetimi
Bölüm	Araştırma Makaleleri
Yazarlar	Olcay Özen 0000-0001-6562-8286 İlker Köse 0000-0002-5549-5579 Pakize Yıgıt 0000-0002-5919-1986 Şeyma Güner 0000-0002-9591-9276 Sabahattin Aydın 0000-0001-6374-817X
Yayımlanma Tarihi	27 Mart 2024
Yayımlandığı Sayı	Yıl 2024 Cilt: 13 Sayı: 1

Kaynak Göster

APA	Özen, O., Köse, İ., Yıgıt, P., Güner, Ş., vd. (2024). Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 13(1), 441-452. https://doi.org/10.37989/gumussagbil.1225744
AMA	Özen O, Köse İ, Yıgıt P, Güner Ş, Aydın S. Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. Mart 2024;13(1):441-452. doi:10.37989/gumussagbil.1225744
Chicago	Özen, Olcay, İlker Köse, Pakize Yıgıt, Şeyma Güner, ve Sabahattin Aydın. “Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 13, sy. 1 (Mart 2024): 441-52. https://doi.org/10.37989/gumussagbil.1225744.
EndNote	Özen O, Köse İ, Yıgıt P, Güner Ş, Aydın S (01 Mart 2024) Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 13 1 441–452.
IEEE	O. Özen, İ. Köse, P. Yıgıt, Ş. Güner, ve S. Aydın, “Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week”, Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, c. 13, sy. 1, ss. 441–452, 2024, doi: 10.37989/gumussagbil.1225744.
ISNAD	Özen, Olcay vd. “Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 13/1 (Mart 2024), 441-452. https://doi.org/10.37989/gumussagbil.1225744.
JAMA	Özen O, Köse İ, Yıgıt P, Güner Ş, Aydın S. Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2024;13:441–452.
MLA	Özen, Olcay vd. “Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, c. 13, sy. 1, 2024, ss. 441-52, doi:10.37989/gumussagbil.1225744.
Vancouver	Özen O, Köse İ, Yıgıt P, Güner Ş, Aydın S. Analysis of Density and Patient Wait Times In Terms of System Management In Turkish Hospitals: Setting A Pattern by Days and Hours of The Week. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2024;13(1):441-52.

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