Steadily growing flow of patients and a constant increase in the requirements for the quality of medical care more and more often lead to the need to reorganize the work of various departments of medical hospitals. However, such actions are very costly and do not always give the desired result. One of the effective methods of preliminary planning, as well as predicting the results of proposed transformations, is the method of simulation modeling of medical and diagnostic processes based on a specially created model. In this article we describe the original data on the operation of the admission and diagnostics department (ADD) of N.V. Sklifosovsky Institute, which served as one of the grounds for its reorganization, as well as the creation of a simulation model of ADD, reconstructed on the principles of a patient-oriented approach. We considered all stages of the model construction in detail and thereby justified its structure and the qualitative and quantitative parameters which formed the basis therein. The temporal and numerical results of modeling the flow of patients through the ADD, as well as the flow of changes in the parameters of the model to the throughput of the ADD are presented. Thus, specific examples show how problem areas of the existing diagnostic and treatment process can be identified, and what options are available for its optimization and modernization. In addition, suggestions are made for further improvement of the created model and options for its use, for example, for the study of various contingencies and emergencies, mass revenues, etc.

Background The most important part of the state social and economic policy is optimization of the healthcare system, where the loss of public health leads to economic damage. Against this background, forecasting the work of medical institutions is the basis for the successful development of healthcare, despite the fact that the healthcare system, indicators and standards of medical and social welfare are still not stable, and a clear development strategy for the shortand long-term period has not been worked out. Aim of study Determining the most optimal method for predicting the work of a medical institution, based on identification of the main trends in the time series when constructing a model of the dependence of parameters or determining the behavior of data as a stochastic series (i.e. modeling random processes and random events with some random error).Material and methods To predict the main statistical indicators of N.V. Sklifosovsky Research Institute for Emergency Medicine based on a retrospective analysis, data were used that were submitted to the City Bureau of Medical Statistics and entered into official reporting forms (form № 30, approved by Goskomstat of the Russian Federation dated September 10, 2002, № 175): the number of hospitalized patients and mortality rates in inpatient and intensive care units. To select the optimal methodology for the experimental forecast model, data were used for the period from 1991 to 2016. Indicators for 2017 were taken as control values.Results As a result of the comparison of several methods (moving averages, least squares approach, Brown model, Holt–Winters method, autocorrelation model, Box–Jenkins method) as applied to the work of N.V. Sklifosovsky Research Institute for Emergency Medicine, the Holt–Winters model was chosen as the most appropriate one for the data characteristics.Findings 1. When using methods of moving averages, least squares, Box-Jenkins, as well as Brown model and autocorrelation, the forecast result is not always influenced by strictly straight-line indicators of the time series, due to the heterogeneity of the time series and the presence of outliers (often found in a medical institution providing emergency care), which lead to a significant decrease in the reliability of forecasting. 2. The application of the Holt–Winters model, which takes into account the exponential trend (the trend of time series indicators) and additive season (periodic fluctuations observed in the time series), is most suitable for processing statistical data and forecasting for long-term, medium-term and short-term periods taking the specifics of a hospital providing emergency care into account. 3. The choice of the optimal method for predicting the work of a medical institution, based on the identification of the main trends in the time series, taking most of the features in the modeling of random processes and events into account, allowed to reduce the relative forecast error.