A decision support tool, implemented in a system dynamics model, to improve the effectiveness in the hospital emergency department

Romano, Elpidio; Guizzi, Guido; Chiocca, Daniela

doi:10.1504/ijpm.2015.066291

Cited by 10 publications

(17 citation statements)

References 9 publications

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“…Similar applications using DES and optimization models can be found at Kuo [174] and Sinreich et al [121]. Other studies expose the integration of simulation with BSC and PRIME [131], FAHP and MAUT [129], DGP [20], lean manufacturing [116,166], six sigma [198], DOE [111,124], approximation algorithm [103], and other OR methods [102] for reducing overcrowding within emergency departments. However, none of these integrations has been widely adopted in the ED context.…”

Section: Papers Focusing On Reducing the Waiting Timementioning

confidence: 80%

“…In this paper, the very-well known "Value Stream Mapping" was found to be useful for detecting non-value added times within Sadi Konuk hospital ED. Similar implementations can be also found in studies such as Martínez et al [176] and Romano et al [116]. As a step towards reducing lengthy waiting times, other methods have been integrated with simulation: BSC and PRIME [131], DEA [162], DGP [20], statistical methods [25], machine learning [171] and group decision-making [125].…”

Section: Papers Focusing On Reducing the Waiting Timementioning

confidence: 89%

“…For instance, the use of hybrid approaches emerging from the combination of several prominent approaches is at the earlier stages and more contributions are then expected to increase the evidence base related to these applications. In particular, the use of combined interventions using simulation and lean manufacturing remains limited in the reported literature [113,115,116,166,176,216]. Likewise, researchers are advised to take into account the methodological trends regarding process improvement in emergency departments.…”

Section: Discussionmentioning

confidence: 99%

“…Integrating simulation and lean techniques is another alternative adopted by researchers and practitioners when dealing with excessive stays in EDs. For example, Romano et al [116] used this approach in conjunction with causal loop diagrams for minimizing the LOS and waiting times in Italian hospitals. Specifically, a new ED configuration was pretested considering the partial reassignment of unused beds and medical staff to patients with white code only.…”

Section: Papers Focusing On Reducing the Extended Losmentioning

confidence: 99%

“…Such integration led decision-makers to identify potential improvement opportunities and propose solutions with an estimated 7-minute flow time reduction. The amount of time spent in EDs was also evaluated in Romano et al [116] through the combination of lean healthcare, simulation, and causal loop diagrams. This framework was implemented in an Italian ED where positive results in patients' flow were further evidenced with subsequent reductions of profit loss.…”

Section: Papers Focusing On Diminishing the Patient Flow Time In Edmentioning

confidence: 99%

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Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

Ortíz‐Barrios

Alfaro-Saiz

2020

IJERPH

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The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.

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Section: Papers Focusing On Reducing the Waiting Timementioning

confidence: 80%

Section: Papers Focusing On Reducing the Waiting Timementioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Papers Focusing On Reducing the Extended Losmentioning

confidence: 99%

Section: Papers Focusing On Diminishing the Patient Flow Time In Edmentioning

confidence: 99%

See 3 more Smart Citations

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

Ortíz‐Barrios

Alfaro-Saiz

2020

IJERPH

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Implementation of lean in health care environments: an update of systematic reviews

Lima

Dinis‐Carvalho

Souza

et al. 2020

IJLSS

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Purpose Even though the implementation of lean in health care environments is relatively recent, it has been receiving a lot of attention in recent years. Partly because of the fact that it is a recent field of practise and research and partly because the number of works developed in this field has grown rapidly, it is important to frequently update the perspectives on this field of investigation. Thus, this study aims to review the implementation of lean tools and techniques applied to hospital organizational areas in a five-year period, between 2014 and 2018, complementing some of the most relevant reviews already published. The most important criteria such as tools, methods and principles, hospital areas intervened, improvements and difficulties were assessed and quantified. Design/methodology/approach As starting point for this systematic literature review (SLR), a set of selected pre-existing review publications was used to support the current study and as the ground base for the expansion of the studies about lean health care. The current study contemplated 114 articles from a five-year period between 2014 and 2018. A subset of 58 of these articles was critically assessed to understand the application of lean tools and methods in different hospital areas. Findings The thorough analysis of selected articles show a lack of works in continuous improvement approaches when compared to the application of production organization methods, visual management and diagnosing and problem-solving tools. The reported improvement results demonstrate alignment with the principles and foundations of lean philosophy, but such results are presented in isolated initiatives and without robust evidence of long-term maintenance. Moreover, this study shows an evolution in the number of articles referring to lean implementation in hospital areas, but in its great majority, such articles report isolated implementations in different areas, not spreading those for the global organization. Thus, some of the main recommendations are the need to implement studies on complete flows of patients, drugs and materials, instead of isolated initiatives and strive to promote the cultural change of hospitals through structural changes, following new visions and strategic objectives, supported by real models of continuous structural and sustained improvement. Originality/value The current study develops a new perspective of the articles published under the thematic of lean health care, published in a recent period of five years, which are not completely covered by other works. Additionally, it explicitly applied, in an innovative way, an approach that used a set of previous reviews as the starting point for this SLR. In this way, it integrates approaches and categories from different SLRs, creating a framework of analysis that can be used by future researchers. Finally, it shows the most recent implementations of lean health care, exposing the current trends, improvements and also the main gaps.

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System Dynamics Modelling for Dynamic Emergency Response to Accidents Involving Transport of Dangerous Goods by Road

Zhang

Shen

Hua

et al. 2021

Journal of Advanced Transportation

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For improving the emergency capacities during road transportation accidents of dangerous goods, this paper divides the accident emergency procedure into four subsystems: accident information processing, personnel rescue and evacuation, vehicle evacuation, and rescue materials delivery. On this basis, the causal mechanism and the loop diagrams of the emergency process are established by using the System Dynamics Method and Vensim software. First, six factors including transportation distance, the degree of mechanical modernization, delay time of personnel control, delay time of traffic information release, command level coefficient, and delay time of department arrival are selected as parameters to test the model’s sensitivity analysis. Then, the influences of the abovementioned factors on the observed value, such as the demand gap of on-site materials, number of people in safe area, number of vehicles in safe area, amount of disposal information, and the dynamic evolution behavior of the system, are analyzed. The results show that the transportation distance is shortened by half, and the time to fill the demand gap is reduced by 39%. The level of mechanical modernization is doubled, the peak inventory of materials in transit will increase by 9.2%, and the time to reach the peak will be shortened by 6.8%. If the delay time of personnel control is shortened by 480 s, the number of people to be evacuated in accident area will be reduced by 56. The delay time of traffic information release is shortened by 480 s, the number of vehicles to be evacuated is reduced by 74, and the time when the vehicle stops entering accident area is 1646 s in advance. The command level coefficient increases by 9.5%, and the speed of action execution increases by 9.6%.

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A decision support tool, implemented in a system dynamics model, to improve the effectiveness in the hospital emergency department

Cited by 10 publications

References 9 publications

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

Implementation of lean in health care environments: an update of systematic reviews

System Dynamics Modelling for Dynamic Emergency Response to Accidents Involving Transport of Dangerous Goods by Road

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