The emergency department of a hospital is, among all areas in which lean policies are focused, the one that has received the most attention. The emergency room, in fact, plays a vital role in providing primary care to patients and is also recognized for the contribution it gives to society. The important results in terms of cost savings and improving the flow due to the reduction of the waiting time of the patients, obtained from major international hospitals, were crucial to assess whether it was possible and useful to implement similar improvements in Italy, certainly not without to many problems in the provision of health services. This paper explores what can be improved for the department to be more efficient, using simulation techniques based on dynamic and continuous logics (system dynamics)

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