Use System Simulation for Programming Emergency Medical Operations: Allocated the Most Appropriate and Performance Evaluation
Date Issued
2012
Date
2012
Author(s)
Wang, Lee-Min
Abstract
Background
In recent years, increasing patient census and department overcrowding are universal concerns in emergency department of medical center. Accurate predictions of patient flow and resource utilization in the emergency department are important in determining what aspects of emergency department operation could be modified to improve patient flow, reduce patient waiting times, and increase staff efficiency and morale, and thus direct change more effectively. In order to reach higher quality of emergency department operations based on teaching hospital as principle operating environment. We developed to use a computer simulation model of emergency department operations using simulation software (Simul 8). This model uses multiple levels of preemptive patient priority; assigns each patient to an individual nurse and physician; incorporates all standard tests, procedures, and consultations; and allows patient service processes to proceed simultaneously, sequentially, repetitively, or a combination of these to provide patients more efficient and professional medical care in emergency department. In other words, medical professionals can act against the clock, and reach the highest objective of life saving in emergency medical environment. This study is set forth to examine whether the quality and efficiency of emergency care will be improved by adjusting the order of procedures in the ED.
This study used 66,095 records of emergency patients in an emergency department of a medical center from 2010-1 to 2010-12. We got some valuable points (N=60,366) from this study in considering re-engineering of emergency room in medical centers, which filled up the gaps of current understandings and myths of organizational restructures.
Objectives
1.Use the discrete event simulates (DES) rationale to build a model for the emergency patients to receive a proper medical diagnostic flow. Verify and valid it feasibility.
2.Understand the working flow of the emergency department, the special characteristic distribution of the emergency patient, the time distribution of working process and situation of patient’s waiting time in the object hospital emergency department.
3.Simulate by the system to get a model of establishing proper medical diagnostic flow, reducing the patient’s waiting time, promoting quality and reducing the wasted resources.
4.Study the factors that influence the emergency department working flow，further understand which factor affects each time variation of the triage.
5.Apply the emergency department model time’s forecast pattern to the resources distribution design of the object hospital emergency department and to find the best resolution from the National Emergency Department Overcrowding Scale.
Methods
1. Analyze current emergency department operations.
2. Interview and discuss medical operating procedures and operating experience with doctors and related people.
3. Discuss the framework and technology requirement with professionals of emergency department operations.
4. Plan flow chart.
Result
An ED simulation model was developed involving a cooperative effort at affiliated teaching hospital with medical center in Taiwan over a year period. We developed the model with a preexisting data set, along with institutional information and expert clinician input. The ED department has a 94 non-trauma bed capacity in the ED, divided into three individual areas. Specifically, these are: the Resuscitation Room (RM), with 10 beds reserved for critical care; the Main Emergency Department (MED), with 7 fixed beds and the Observation Unit (OU), with 77 beds in the OU. In this study, we simulate a model according to the situation in ED by System Simulation Technique, and use it to analyze the waiting time and system time of NEDOCS as indicator to determine the ED flow, find the optimization ways to prove the corrected model.
We apply system simulation to build an emergency simulation model, to investigate the actual resource distribution recently. Then, learn the output from different resources reallocation model, analysis the efficiency of different model by Data Envelopment Analysis (DEA); compare this result with the actual situation.
We use a mixed method combing DES and DEA models to identify the best performing operations across multiple alternatives. To the allocation simulation optimization and efficiency evaluation. To find DMU 12 with the optimization in the high efficiency evaluation. By the efficiency evaluation, we got DMU2 in the lower efficiency condition.
Conclusion
We provide a mixed method combing DES and DEA models to identify the best performing operations across multiple alternatives. The efficiency of DMUs across multiple alternatives allows for a richer benchmarking analysis to allocate simulation optimization and efficiency evaluation.
Subjects
Emergency Department
System Simulation
Queuing Theory
Hospital Management
Discrete Event Simulation (DES)
Data Envelopment Analysis (DEA)
SDGs
Type
thesis
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