Simulation methods in the healthcare systems

International audienceHealthcare systems can be considered as large-scale complex systems. They need to be well managed in order to create the desired values for its stakeholders as the patients, the medical staff and the industrials working for healthcare. Many simulation methods coming from other sectors have already proved their added value for healthcare. However, based on our experience in the French heath sector (Jean et al. 2012), we found these methods are not widely used in comparison with other areas as manufacturing and logistic. This paper presents a literature review of the healthcare issue and major simulations methods used to address them. This work is design to suggest how more systematic creation of solutions may be performed using complementary methods to resolve a common issue. We believe that this first work can help to better understand the simulation approaches used for health workers, deciders or researchers of any responsibility level

Factors Analyze on the Performance of Nurses in the Implementation of Patient Safety

Nurse have an important good role for safety of patients by monitoring the patients\u27 condition to prevent the occurrence of incidents, provide health education, detect faults and near misses, and perform other tasks to solve a problem of the patients by high-quality care. The problems have been existing in ER related to the implementation of patient safety is that the patient safety has not been accomplished in accordance with the SPO and Patient Safety Guide. The purpose of this study is to analyze the factors associated with the performance of nurses in the implementation of patient safety. The research uses analytical descriptive design with cross sectional approach. The number of samples used is 23 respondents with total sampling technique . The calculation results of multiple regression analysis of patient safety knowledge factors have the most dominant influence with standardized ß coefficient of 0.678 and 0.329 meaning that it has a significant effect while the supervision does not. Optimizing the development of the individual nurse requires efforts to increase knowledge and skills in the context of patient safety; therefore, they are able to show high-quality performance

Tingkat Ketergantungan Dan Lama Perawatan Pasien Rawat Observasi Di IGD

An imbalances between number of patients beimg admitted in Emergency Department (ED) and the availability of beds in it's department have an impact on the length of stay of patient who actually have to be discharged from ED. This problem will affect to the additional nurses activity and the workload, as these pastient should wait to the availability of rooms for the inpatient care in the transient rooms. Based on this situation, it is important to identify the level of dependency of patient during the observation period in transient rooms, and the time consumtion for delivering nursing care service, since it's being the responsibility of ED nurses. This data was collected through observations and analyzed with descriptive analysis (percentage). Consecutive sampling technique was administered 74 patients who receives nusing service in this transient room involved in this study. The results of this study obtained that distribution of level dependency of observed patients was minimal dependency (37.84%), medium (25.68%), (24.32%) is higher dependency, and maximal dependency (12.16%). The average time consumtion for nursing care delivery is 19 minutes/nurses/shift, and the total time consumtion is 3,72 hours/day. The implication of this study is for the Hospital need to evaluate the additional workload of the ED nurses, and need to plan the availability of transient room out side the ED

Bottleneck Detection and Reduction Using Simulation Modeling to Reduce Overcrowding of Hospital Emergency Department

Overcrowding is a common problem in hospital emergency departments (EDs) where the ED service cannot meet care demands within reasonable time frames. This paper introduces a quantitative approach using computer simulation modeling for hospital decision makers to explore trade-offs between efficiency, workload and capacity of EDs. A computer simulation model is built based on the ED of a local hospital to improvement efficiency of the ED patient flow. Bottlenecks of the emergency care process are detected using the built model. The ED performance is examined by applying alternative strategies to reduce patient waiting time and length of stay. The proposed method can be applied to improve the operation efficiency of healthcare systems in the current pandemic, COVID -19

Analysis, modeling, and simulation of emergency department

Overcrowding in the Emergency Department (ED) is one of the most important issues in healthcare systems. Two major causes of this congestion are identified, the first one is unjustified Emergency Department visits and the second one a lack of downstream beds. The lack of downstream beds can deteriorate the quality of care for patients who need hospitalization after an ED visit. In this paper a generic simulation model is developed in order to analyse patient pathways from the ED to hospital discharge

Una estimación de respuesta en caso de sismo grave

Objetivos: describir las características generales que tienen los servicios de emergencia de los hospitales de la ciudad de Guayaquil; el flujo de pacientes, las proporciones de internamiento y cirugías de emergencia, las tasas de ocupación y la disponibilidad de camas, estimando la posibilidad de atender un aumento súbito de la demanda por un desastre natural, modelar una situación de incremento estimando la capacidad de atención en función de la disponibilidad de camas. Diseño del estudio: transversal para la descripción de los servicios de emergencia de cinco hospitales de la provincia del Guayas y se simuló un incremento lineal de la demanda de servicios para evaluar la capacidad de atención. Resultados: las atenciones de emergencia se han incrementado significativamente en los últimos cinco años, mientras que las tasas de internamiento por emergencia han disminuido; la disponibilidad de camas por habitante no se ha incrementado y el número de camas disponibles está poco más arriba de 200 por día en promedio. Conclusiones: los hospitales que tendrían mayor porcentaje de capacidad de atención serían el León Becerra, el Naval y el Militar. Los hospitales del sector del sur y oeste de la ciudad, son los que tendrían menor capacidad para atender un mayor volumen de pacientes

Uso inadequado do Pronto-Socorro Pediátrico

OBJECTIVE: To identify the reasons for seeking the Pediatric Emergency Room (PER) of a city in the state of São Paulo and define the profile of users who seek the service. METODOLOGY: Observational prospective study conducted from February to August 2021, through structured interviews with guardians of children taken to the PSP with a form developed for the research containing sociodemographic and clinical information, in addition to the emergency classification at the time of triage. Data were presented as mean ± standard deviation (SD) or absolute frequency and percentage. RESULTS: A total of 252 caregivers were interviewed, with the majority being mothers (76.2%) or fathers (15.9%), with a mean age of 32 years (SD=±8.7). High or moderate level of concern about the childs health status was answered by 91.6% of caregivers, although most cases were classified at screening as minor or not urgent (77.3%). CONCLUSION: The level of concern of the caregiver and the belief that PER provides more effective care motivated the non-urgent search for this service. The data reflect the need for health education to raise awareness of the flow of care in the Unified Health System, identifying primary health care as the gateway to the system and the PER as a place intended for urgent and emergency care. Ultimately, it is intended to contribute to the provision of care in a qualified manner to the comprehensive health of the child

Successful implementation of discrete event simulation: the case of an Italian emergency department

This paper focuses on the study of a practical management problem faced by a healthcare {\it emergency department} (ED) located in the north of Italy. The objective of our study was to propose organisational changes in the selected ED, which admits approximately 7000 patients per month, aiming at improving key performance indicators related to patient satisfaction, such as the waiting time. Our study is based on a design thinking process that adopts a {\it discrete event simulation} (DES) model as the main tool for proposing changes. We used the DES model to propose and evaluate the impact of different improving scenarios. The model is based on historical data, on the observation of the current ED situation, and information obtained from the ED staff. The results obtained by the DES model have been compared with those related to the existing ED setting, and then validated by the ED managers. Based on the results we obtained, one of the tested scenarios was selected by the ED for implementation.Comment: 24 pages, 8 figures and 4 table

Tingkat Ketergantungan dan Lama Perawatan Pasien Rawat Observasi di IGD

Ketidakseimbangan jumlah pasien dan ketersediaan ruang rawat dapat berakibat pada memanjangnya masa rawat pasien di Instalasi Gawat Darurat (IGD). Hal tersebut berdampak pada bertambahnya aktivitas dan beban kerja perawat selama pasien menunggu ketersediaan ruang rawat inap di ruang IGD. Berdasarkan situasi tersebut, penting untuk mengidentifikasi tingkat ketergantungan pasien selama periode rawat observasi dan rata-rata waktu yang digunakan untuk perawatan pasien rawat observasi selama pasien menjadi tanggung jawab perawat IGD. Penelitian deskriptif dilakukan melalui observasi terhadap pasien yang menjalani rawat observasi di IGD dan intervensi keperawatan yang diterima, serta jumlah waktu yang dipergunakan dalam perawatan tersebut. Teknik consecutive sampling dipergunakan untuk menetapkan pasien sebagai sampel penelitian.dan sebanyak 74 pasien rawat observasi dilibatkan dalam penelitian ini. Data dianalisis secara deskriptif. Hasil penelitian menunjukkan bahwa sebaran tingkat ketergantungan pasien rawat observasi adalah ketergantungan minimal (37,84%), sedang (25,68%), agak berat (24,32%), dan maksimal (12,16%). Rata-rata waktu yang digunakan untuk perawatan pasien rawat observasi 19 menit/perawat/shift dan total waktu 3,72 jam perhari. Implikasi penelitian bagi rumah sakit yaitu perlu dilakukan evaluasi terhadap adanya peningkatan beban kerja perawat IGD dan perencanaan kebutuhan ruang transientdi luar IGD