Modeling, Assessment and Design of an Emergency Department of a Public Hospital through Discrete-Event Simulation

Abstract

Emergency departments in hospitals are having many difficulties in achieving the performance levels required by health regulators and society. The waiting times as well as the total throughput time are examples of performance indicators that emergency departments need to improve in order to provide a better service to the community. To achieve improvement of performance, the present paper shows a methodology to assist the design process of an emergency department using simulation techniques. In this study, the emergency department of a hospital located in the northern region of Portugal was considered to test the proposed simulation technique. The emergency department initial state was assessed, in terms of patient flow, as well as the human resources needed at every stage of the service. In order to understand in depth the process that a patient goes through during an emergency episode, a comprehensive study was performed on the hospital database. This allowed the analytical description of an emergency episode, which was further used as an input to the simulation model. After developing the simulation model with the information obtained by the hospital’s database, a validation stage was performed. Finally, in order to achieve an optimized design for the emergency department several variant scenarios were considered and evaluated. This methodology proved to be very useful in determining an optimized operation for complex, and non-linear systems.

Queueing Problems in Emergency Departments: A Review of Practical Approaches and Research Methodologies

“…He concluded that issues in hospital were well resolved through that simulation and modifications in queueing have been done. Castanheira-Pinto et al [ 180 ] presented a methodology to assist the design process of an ED using a DES simulation technique. The ED of a hospital in Portugal was considered for testing that technique.…”

Modelling Granular Process Flow Information to Reduce Bottlenecks in the Emergency Department

“…However, upon gaining the higher-level view, a detailed process model is needed for a better understanding of the intricacies on the ground. Solutions underpinned by Operations Research/Management (OR/OM) methods, including simulation techniques, have been commonly used to solve bottlenecks in the ED [23,57,[61][62][63][64]. For example, Discrete Event Simulation (DES) has been applied to model EDs at an operational level [64,65].…”

Aplicação do Mapeamento de Fluxo de Valor e Lean Healthcare na emergência de um hospital de referência regional

“…O departamento de emergência tem estado sob pressão crescente, impactando diretamente a capacidade de atendimento. Além disso, tem dificuldades em atingir os níveis de desempenho exigidos pelos reguladores de saúde e pela sociedade (Castanheira-Pinto et al, 2021;Swancutt et al, 2017). Ademais, a demanda contínua e os orçamentos apertados levam alguns hospitais a apresentar baixo desempenho, impactando a satisfação do paciente (Alnajem et al, 2019).…”

“…No entanto, não há acordo sobre como definir metas de tempo de espera e priorizar listas de espera. Assim, os tempos de espera e o tempo total de processamento são exemplos de indicadores de desempenho que precisam ser gerenciados e reduzidos nos prontos-socorros, de forma a atender melhor a comunidade (Castanheira-Pinto et al, 2021). Para isso, a abordagem LH tem sido adotada (Swancutt et al, 2017).…”

“…Tendo em vista a importância da eficiência dos sistemas hospitalares, a problemática dessa pesquisa caracteriza-se pelo alto valor e variação do lead time no fluxo de paciente no departamento de emergência (Burström et al, 2013;Castanheira-Pinto et al, 2021;Swancutt et al, 2017). Desta forma, esta pesquisa explora a seguinte questão de pesquisa: Como o mapeamento de fluxo de valor pode contribuir na identificação de desperdícios e na proposição de melhorias no âmbito do fluxo de pacientes no departamento de emergência?…”