Emergency ward simulation

Emergency ward simulation Claus Ørum-Hansen Simulation Symposium, Lyngby 7.November 2013

Building a Emergency ward simulation model, the key questions to be answered are What? Where? When? How many? Personnel Rooms Equipment 2

Specifying the simulation model of the Emergency Ward In and out data must be specified Parameters describing patients, personnel, and processes Results and statistics Patients Arrivals Flows (Kontaktårsagskort) Personnel Doctors Nurses Porters Other Input Output Per unit in total and over time Production Flow (lead times) Processes Functions Capacities Timing and duration Input Resource utilisation Parameters describing the production system Infrastructure Layout (architecture) Rooms / beds / equipment Complexity drivers Break downs Random variation 3

Patient arrivals for each week day Some data are easy to get 14 12 10 8 6 4 2 0 Ankomster pr time 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Ugedag Time0 Time1 Time2 Time3 Time4 Time5 1 2,09% 1,25% 0,97% 0,81% 0,89% 0,58% 2 1,95% 1,46% 1,16% 1,00% 0,93% 0,90% 3 1,92% 1,39% 0,97% 0,71% 0,80% 0,62% 4 2,15% 0,96% 1,06% 0,72% 0,72% 0,83% 5 1,99% 1,45% 1,30% 0,95% 0,91% 0,82% 6 2,81% 2,45% 1,51% 1,30% 0,83% 1,04% 7 3,28% 2,42% 1,81% 1,54% 1,24% 1,11% 4

Hurtigst Normalt Langsomst Hurtigst Normalt Langsomst TidMlmBesøg Tid skalerbar ID Procent ID Procent ID Procent Afventer ID Afventer ID Afventer ID Afslutter alle akt. Min. erfaring I seng Aktivitet med P Eskorteres BehandlingsTim ParallelID RumFrigivesEft Standardaktivit Patient flow Other data segments requires a big effort 100% Pt Bed Arrival / Triage 100% 20% 80% 100% Blood test sample 100% 100% Treatment start Doc 100% Treatment start Nurse 100% 100% 100% ID Aktivitet Per.Res Kommentar Blood test analysis Treatment plan I Monitoring Reception by Nurse 50% Other specialty involved 1 Ankomst / Triage Triage- Vitalværdier + 5 8 15 2 20% 3 80% Triagerum 1 1 1 4 Blodprøvetagning Spl Blodprøver tages i und.rum 50% 5 10 15 5 100% Und.Rum 1 3 Treatment plan II Other specialty involved Treatment plan III Release / Transfer Doc Release / Transfer Nurse 20% 80% 5 Repeated 2 Pt --> Seng Spl Pt lægges i seng med tøj på 4 7 15 3 100% 1 Und.Rum 1 1 2 3 Parallel-header 6 100% 7 100% 4 100% Und.Rum 1 2 5 Blodprøveanalyse inkl transporttid - foregår på 45 60 120 1 3 6 Behandlingsstart Læge Læge Lægen påbegynder 10 15 25 x 9 100% 1 Und.Rum 1 4 7 Behandlingsstart Spl Spl Spl påbegynder EKG og andre 10 15 60 x 8 100% 1 Und.Rum 1 4 8 Sygeplejemodtagelse Spl Skifte tøj 5 10 15 15 30 60 x 15 100% 1 Und.Rum 1 5 9 Behandlingsplan I Læge Behandlingsplan I + diktere 10 15 30 x 10 50% 16 50% 1 Und.Rum 1 1 6 10 CT Spl CT 60 180 360 11 100% CT 1 1 1 7 11 Behandlingsplan II Læge Behandlingsplan II + diktere 15 20 40 x 13 20% 16 80% -1 2 Und.Rum 1 6 12 Pt --> Seng Spl Pt lægges i seng (20%); 80% 4 7 15 13 100% 1 Und.Rum 1 1 2 13 Senge/obs-område observation i AM-område 360 480 1440 14 100% Und.Rum -1 8 14 Behandlingsplan III Læge Behandlingsplan III + diktere 10 15 20 x 16 100% 2 Und.Rum 1 6 15 Sygeplejetilsyn Spl Aktivitet foregår med jævne 2 5 10 60 1 Und.Rum 1 9 16 Udskrivning / Læge Inkl orientering og 10 15 20 17 100% 1 Und.Rum 1 10 17 Udskrivning / Spl Praktisk udskrivning, medicin 3 10 20 x 1 Und.Rum -1 1 1 10 RumType Udstyr

Personnel Duties 25 20 15 10 5 0 Vagtplan 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Læge Spl Triage-spl/Triage-sekr Vagtplan Time Læge Spl Triagespl/Triagesekr 0 2 2 1 1 2 2 1 2 2 2 1 3 2 2 1 4 2 2 1 5 2 2 1 6 2 2 1 7 2 2 1 8 10 8 2 9 10 8 2 10 10 8 2 11 10 8 2 12 10 8 2 13 10 8 2 14 10 8 2 15 10 8 2 16 10 8 2 17 10 8 2 18 10 8 2 19 10 8 2 20 5 4 1 21 5 4 1 22 5 4 1 23 2 2 1 6

Infrastructure / layout / walking distances / 7

Demo 8

Output data and measure points are numerous PatientID Activity / ID Flow / ID Specialty / ID Activity start time (when reserving resources) Activity actual start time Activity end time Waiting time (by reservation of ressources) Process time for activity Personel / room resources in activity PatientID aktid StandardAktID ForløbID SpecialeID AktStartTidSeize AktStartTid AktSlutTid TidSeize TidAktivitet persrestype RumResType ForløbFærdig StandardAktNavn persrestypenavn RumResTypeNavn Time Ugedag 1 1 1 4 1 0-00:01 0-00:02 0-00:10 00:00 00:08 3 1 1 Ankomst / Triage Triage-spl/Triage-sekr Triagerum 0 1 1 2 2 4 1 0-00:10 0-00:10 0-00:18 00:00 00:07 2 2 1 Diverse Spl Und.Rum 0 1 1 7 4 4 1 0-00:18 0-00:18 0-00:35 00:00 00:17 0 2 1 Behandlingsstart Dummy Und.Rum 0 1 1 8 4 4 1 0-00:18 0-00:18 0-00:43 00:00 00:24 2 2 1 Behandlingsstart Spl Und.Rum 0 1 1 5 3 4 1 0-00:18 0-00:18 0-00:31 00:00 00:13 2 2 1 Blodprøve Spl Und.Rum 0 1 2 1 1 1 1 0-00:22 0-00:22 0-00:31 00:00 00:08 9 3 1 1 Ankomst / Triage Triage-spl/Triage-sekr Triagerum 0 1 2 6 4 1 1 0-00:31 0-00:31 0-00:51 00:00 00:19 0 2 1 Behandlingsstart Dummy Und.Rum 0 1

Output data and dimensions from the prototype Utilisation Personnel Time / day Personnel type Number of active resources Utilisation of resources DagID Tid PersonaleType AntalAktive Udnyttelsgrad PersonaleNavn Time Ugedag 1 00:00 1 0 0 Læge 0 1 1 00:00 2 0 0 Spl 0 1 1 00:00 3 0 0 Triage-spl/Triage-sekr 0 1 1 00:00 4 0 0 Portør 0 1 1 00:10 1 0 0 Læge 0 1 1 00:10 2 0 0 Spl 0 1 1 00:10 3 1 0,02 Triage-spl/Triage-sekr 0 1 Room Time / day Room type Number of active resources Utilisation of resources DagID Tid RumType AntalAktive Udnyttelsgrad RumNavn Time Ugedag 1 00:00 1 0 0 Triagerum 0 1 1 00:00 2 0 0 Und.Rum 0 1 1 00:00 4 0 0 CT 0 1 1 00:00 5 0 0 Røntgen 0 1 1 00:10 1 1 0,5 Triagerum 0 1 1 00:10 2 0 0 Und.Rum 0 1 10

Output data and dimensions from the prototype Through put times Flow ID / Name Specialty Start time / date End time / date PatientID ForløbID SpecialeID AktStartTidSeize AktSlutTid Gennemløbstid ForløbFærdig Time Ugedag Forløbnavn 1 4 1 00:01:34 02:54:37 02:53:03 1 0 1 14-Ekstremitetskader 2 1 1 00:21:53 01:35:23 01:13:30 1 0 1 36-Mave-flankesmerter 3 1 1 00:56:38 02:13:53 01:17:15 1 0 1 36-Mave-flankesmerter 4 1 1 01:20:18 02:42:26 01:22:07 1 1 1 36-Mave-flankesmerter 5 4 1 01:37:52 04:06:57 02:29:05 1 1 1 14-Ekstremitetskader 6 1 1 01:56:56 05:31:13 03:34:17 1 1 1 36-Mave-flankesmerter 7 7 0 02:08:02 03:28:16 01:20:13 1 2 1 33-Kvalme og/eller opkastning 8 1 1 03:08:45 10:49:55 07:41:11 1 3 1 36-Mave-flankesmerter 11

Examples of analytical scenarios Scenario: 1. Unlimited human resources 2. Only a few doctors / many other human resources 3. Balanced amount of doctors (a few in the night shift) 12

Scenario 1: Unlimited human resources Number of active human resources Number of utilised rooms 13

Scenario 1: Unlimited human resources Waiting time at triage Patient flow throughput time 14

Scenario 2: Only a few doctors / many other human resources Number of active human resources Number of utilised rooms 15

Scenario 2: Only a few doctors / many other human resources Waiting time at triage Patient flow throughput time 16

Defining scenario 3: Balanced amount of doctors Dimensioning personnel duties based on unlimited resources Number of active human resources 17

Scenario 3: Balanced amount of doctors (a few in the night shift) Number of active human resources Number of utilised rooms 18

Scenario 3: Balanced amount of doctors (a few in the night shift) Waiting time at triage Patient flow throughput time 19

Scenario 4: 130 vs 50 examination rooms (many doctors) 130 rooms 50 rooms Throughput time # active examination rooms 20

Scenario 5: 50 examination rooms (balanced amount of doctors) Throughput time # active examination rooms 21

Questions 22