Simulation Optimization for Healthcare Emergency Departments

AbstractThis article presents an Agent-Based modeling (ABM) simulation to design a decision support system (DSS) for Healthcare Emergency Department (ED). This DSS aims to aid EDs heads in setting up management guidelines to improve the operation of EDs. This ongoing research is being performed by the Research Group in Individual Oriented Modeling (IoM) at the University Autonoma of Barcelona (UAB) with close collaboration of Hospital ED Staff Team. The objective of the proposed ABM procedure is to optimize the performance of such complex and dynamic Healthcare EDs, because worldwide most of them are overcrowded, and unable to provide ad hoc care, quality and service. Exhaustive search (ES) optimization is used to find out the optimal ED staff configuration, which includes doctors, triage nurses, and admission personnel, i.e., a multidimensional problem. An index is proposed to minimize patient length of stay in the ED. The results obtained by using an alternative pipeline scheme to ES are promising and a better understanding of the problem is achieved. The impact of the pipeline scheme to reduce the computational cost of exhaustive search is outlined

A data-driven agent based simulation platform for early health economics device evaluation

Health economics is a relatively new but growing field within the discipline of economics and is concerned with making the best use of scarce resources. Early health economic estimates of new medical devices, in particular, can assist producers of health technology in making appropriate product design and investment decisions. It allows companies to understand their likely market and possible reimbursement more thoroughly. Despite the many advantages of point-of-care testing the key problem facing decision makers at the moment is the poor understanding of the potential value gained from new or alternative product or service offerings. Understanding medical device features in the wider market place can be addressed used agent based modelling and simulation (ABMS). In this paper we examine the use of ABMS underpinned by a novel data-driven approach to model generation. A sepsis use case is presented where pathway and device characteristics are defined using the ‘headroom’ method and a semantic evidence capture application. Types and sub-types are automatically extracted into agent models and subsequently executed in our own data-driven agent based simulation platform (TEASIM). A highly typed data-driven approach is evaluated in a manner that clearly presents the technical aspects of TEASIM platform and its practical usage. Initial evaluation of a data-driven approach (and the TEASIM platform) is positive. The approach offers a viable guide to product development in a cost-effective manner, especially in the earlier stages when deciding between potential product configurations or features.Innovate UK provided the funding for the Tea-PoCT project

Towards the Holy Grail: combining system dynamics and discrete-event simulation in healthcare

The idea of combining discrete-event simulation and system dynamics has been a topic of debate in theoperations research community for over a decade. Many authors have considered the potential benefits ofsuch an approach from a methodological or practical standpoint. However, despite numerous examples ofmodels with both discrete and continuous parameters in the computer science and engineering literature,nobody in the OR field has yet succeeded in developing a genuinely hybrid approach which truly integratesthe philosophical approach and technical merits of both DES and SD in a single model. In this paperwe consider some of the reasons for this and describe two practical healthcare examples of combinedDES/SD models, which nevertheless fall short of the “holy grail” which has been so widely discussed inthe literature over the past decade

A distributed simulation methodological framework for OR/MS applications

Distributed Simulation (DS) allows existing models to be composed together to form sim- ulations of large-scale systems, or large models to be divided into models that execute on separate computers. Among its claimed benefits are model reuse, speedup, data pri- vacy and data consistency. DS is arguably widely used in the defence sector. However, it is rarely used in Operations Research and Management Science (OR/MS) applications in areas such as manufacturing and healthcare, despite its potential advantages. The main barriers to use DS in OR/MS are the technical complexity in implementation and a gap between the world views of DS and OR/MS communities. In this paper, we propose a new method that attempts to link together the methodological practices of OR/MS and DS. Using a rep- resentative case study, we show that our methodological framework simplifies significantly DS implementation.This research was funded by the Multidisciplinary Assessment of Technology Centre for Healthcare (MATCH), an Innova- tive Manufacturing Research Centre (IMRC) funded by the Engineering and Physical Sciences Research Council (EPSRC) (Ref: EP/F063822/1 )

A distributed simulation methodology for large-scale hybrid modelling and simulation of emergency medical services

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonHealthcare systems are traditionally characterised by complexity and heterogeneity. With the continuous increase in size and shrinkage of available resources, the healthcare sector faces the challenge of delivering high quality services with fewer resources. Healthcare organisations cannot be seen in isolation since the services of one such affects the performance of other healthcare organisations. Efficient management and forward planning, not only locally but rather across the whole system, could support healthcare sector to overcome the challenges. An example of closely interwoven organisations within the healthcare sector is the emergency medical services (EMS). EMS operate in a region and usually consist of one ambulance service and the available accident and emergency (A&E) departments within the coverage area. EMS provide, mainly, pre-hospital treatment and transport to the appropriate A&E units. The life-critical nature of EMS demands continuous systems improvement practices. Modelling and Simulation (M&S) has been used to analyse either the ambulance services or the A&E departments. However, the size and complexity of EMS systems constitute the conventional M&S techniques inadequate to model the system as a whole. This research adopts the approach of distributed simulation to model all the EMS components as individual and composable simulations that are able to run as standalone simulation, as well as federates in a distributed simulation (DS) model. Moreover, the hybrid approach connects agent-based simulation (ABS) and discrete event simulation (DES) models in order to accommodate the heterogeneity of the EMS components. The proposed FIELDS Framework for Integrated EMS Large-scale Distributed Simulation supports the re-use of existing, heterogeneous models that can be linked with the High Level Architecture (HLA) protocol for distributed simulation in order to compose large-scale simulation models. Based on FIELDS, a prototype ABS-DES distributed simulation EMS model was developed based on the London EMS. Experiments were conducted with the model and the system was tested in terms of performance and scalability measures to assess the feasibility of the proposed approach. The yielded results indicate that it is feasible to develop hybrid DS models of EMS that enables holistic analysis of the system and support model re-use. The main contributions of this thesis is a distributed simulation methodology that derived along the process of conducting this project, the FIELDS framework for hybrid EMS distributed simulation studies that support re-use of existing simulation models, and a prototype distributed simulation model that can be potentially used as a tool for EMS analysis and improvement.MATCH Programm