Optimization of Resources to Improve Patient Experience in the New Emergency Department of Mater Hospital Dublin

Healthcare systems globally are facing capacity issues due to the increased demand of health services, the high cost of resources and the level of quality anticipated of service providers. Emergency Departments (ED) are the most pressurized unit in healthcare systems due to uncertainty in demand and limited resources allocated. Mater Hospital (one of leading hospitals) in Dublin has built a new (state-of-the-art) unit for ED yet faced an issue in resourcing the unit to optimize performance. This paper presents an integrated solution to optimize the capacity of the new ED before opening to public and examine improvement interventions in the ED area. This solution provides ED management with a tool that can contribute significantly in enhancing patient experience by reducing the waiting time from 21 hours to 6 hours while achieving utilization below the 80% burn-out threshold. The model is recommended by Health Service Executives to be used national wide

Simulation-based Framework to Improve Patient Experience in an Emergency Department

The global economic crisis has a significant impact on healthcare resource provision worldwide. The management of limited healthcare resources is further challenged by the high level of uncertainty in demand, which can lead to unbalanced utilisation of the available resources and a potential deterioration of patient satisfaction in terms of longer waiting times and perceived reduced quality of services. Therefore, healthcare managers require timely and accurate tools to optimise resource utility in a complex and ever-changing patient care process. An interactive simulation-based decision support framework is presented in this paper for healthcare process improvement. Complexity and different levels of variability within the process are incorporated into the process modelling phase, followed by developing a simulation model to examine the impact of potential alternatives. As a performance management tool, balanced scorecard (BSC) is incorporated within the framework to support continual and sustainable improvement by using strategic-linked performance measures and actions. These actions are evaluated by the simulation model developed, whilst the trade-off between objectives, though somewhat conflicting, is analysed by a preference model. The preference model is designed in an interactive and iterative process considering decision makers preferences regarding the selected key performance indicators (KPIs). A detailed implementation of the framework is demonstrated on an emergency department (ED) of an adult teaching hospital in north Dublin, Ireland. The results show that the unblocking of ED outflows by in-patient bed management is more effective than increasing only the ED physical capacity or the ED workforce

Using discrete event simulation to improve the patient care process in the emergency department of a rural Kentucky hospital.

The patient care process of a rural Kentucky hospital is a complex process that must be flexible in order to deal with a large variety of patient needs and a fluctuating patient volume where all patients are unscheduled. A simulation model of an average month in the emergency department was built using the Arena Simulation package. Methods for creating a simulation using Arena are included in this work. Statistics were generated from a number of different sources to create an accurate representation of the model. The Hospital reporting shows a need to improve on two quality measures being tracked, the length of time a patient is in the emergency department from entry to completion of care, and the number of patients who leave without being seen by the physician (most often due to the length of their waiting room time prior to the initiation of care). Due to the complex nature of the emergency department and its impact by other departments of the Hospital as well as outside factors such as patient demand, the ability to quantify an expected gain from a change to the facility or to a process can be difficult to establish. A simulation model will allow for experiments on the system to be created and observed, thus enabling the Hospital to identify the best opportunities for improvement. Experiments included in this work show changes to the emergency department facility by adding an additional patient treatment bed, and changing a policy regarding transfer of a patient from the emergency department to inpatient care in the Hospital. Both experiments show improvement in quality measures, with reduced waiting room times, fewer patients who leave without being seen by the physician, and an overall reduction in the length of stay from entry to completion of care in the ED. In the creation of the simulation model, an objective was to develop a model that could be used to guide decision through its flexibility and statistical reliability. The model can be used to test a variety of physical or procedural changes to the emergency department, as well as to test to the impacts of increased patient volume

Aplicación de un modelo de simulación para la reducción de los tiempos de atención en un centro médico de urgencias

En los últimos años se ha presentado en el país, un incremento de la demanda de atención en servicios de urgencias, esto se debe, a que los usuarios pueden acceder de manera más rápida al sistema de salud si lo hacen a través de estos servicios, aun si los motivos de consulta no corresponden a necesidades de urgencias; por esta razón, el Gobierno colombiano busca agilizar y mejorar la calidad de la atención en centros de urgencias, y en sus últimas disposiciones ha establecido criterios para asegurar la valoración rápida y ordenada de los pacientes, realizar la priorización de acuerdo a la gravedad y disminuir los riesgos de muerte, complicaciones y discapacidad (Resolución 5596 de 2015 del Ministerio de Salud y la Protección Social). Teniendo en cuenta lo anterior, es importante para los centros médicos de urgencias, ajustar sus procesos de atención con el fin de cumplir con los tiempos de espera establecidos, con eficiencia que permita la sostenibilidad financiera, entendida como, la obtención de los mayores y mejores resultados, empleando la menor cantidad posible de recursos (Ministerio de la Protección Social, 2005). En este proyecto se aplicaron las metodologías de BPM, minería de procesos y simulación con el cual se determinó la cantidad de recurso humano mínimo necesario para mejorar los indicadores de desempeño del proceso de atención de urgencias en un nuevo centro médico de urgencias en Bogotá.In recent years, the demand of emergency services there has been increased, due to the fact that users can access the health system more quickly if they use these services, even if the reasons for medical consultation do not correspond to emergency needs, for this reason, the Colombian government seeks to streamline and improve the care’s quality in emergency centers, and the latest regulations has established a criteria to ensure the rapid and orderly medical assessment of patients, making the priority according to the severity and the reduction of risks of death, Complications and disability (Resolution 5596 of 2015 of the Ministry of Health and Social Protection). Taking into account the above-mentioned, it is important for emergency medical centers adjust the attention processes in order to achieve the objectives related to waiting time, with efficiency that allows financial sustainability such as obtaining the highest and best results, using the least amount of possible resources (Ministry of Social Protection, 2005). The methodologies of BPM, process mining and simulation were applied in this project, which was determined the amount of human resources needed to improve the performance indicators of the emergency care service in a new emergency medical center in Bogota.Magíster en Ingeniería IndustrialMaestrí