Creating a simulation model of INTEGRIS Women's and Children's Services and evaluating needed capacity

The 4th floor of The INTEGRIS Baptist Medical Center in OKC houses Women's and Children's Services, a unit which cares for expecting mothers and women going through labor. This unit operates 24 hours per day and 7 days per week and is operated using three sub-units: Triage, Labor Delivery & Recovery (LDR), and Postpartum. The Senior Design Team (SDT) worked in collaboration with the INTEGRIS Continuous Improvement Team (CIT) to create a simulation model to verify whether the recent recommendations in the capacity allocation of the sub-units, made in response to capacity shortages, adequately service the demand.The SDT began their investigation with a debriefing of previous analysis completed by the CIT. Their study characterized the arrival times, length of stay, and current capacity in each sub-unit. It was found that there was great consistency in admissions, transfers, and discharges both daily and seasonally. The capacity issues experienced by the Women's and Children's Services did not appear to be a result of swings in demand in any one sub-unit. Instead, the sub-units experienced insufficient capacity to meet patient demand. Bottlenecks on the 4th floor caused the typical flow of patients to be altered and compounded capacity issues exhibited in the three sub-units. These observations indicated that there was a need to do a detailed capacity analysis of the 4th floor and to this end we developed a discrete event simulation model.The SDT began the creation of a simulation model by fitting distributions to the data using MATLAB. These distributions were later used to create the simulation model submitted by the SDT. Then, Simio was used to construct a representation of 4th floor operations. The model was verified by peer review and test runs. There were no logical errors in the model and patient flow correctly depicted actual operations. The model was validated by comparing actual demand and length of stay from 2019 data to the results generated by the model. This comparison confirmed that the model accurately represented current operations in Women's and Children's Services.After the simulation model baseline was completed, various alternatives to increase capacity were tested with experiments in Simio. The following alternatives were considered to resolve the capacity issues experienced by the Women's & Children's Services:Triage sub-unito 4-bed option: increased capacity by 1 bedo 5-bed option: increased capacity by 2 bedso 6-bed option: increased capacity by 3 bedsLDR/Postpartum sub-unito Add rooms: added rooms to the LDR/Postpartum sub-unitso LDRP: combined the LDR/Postpartum sub-units by converting all beds in both sub-units to include equipment necessary to care for both LDR and Postpartum patientsAnalysis of the Triage sub-unit showed that the 5-bed option was the most effective method to increase capacity. This alternative decreased wait times by 93%. The 5-bed option incurred a greater cost than the 4-bed option due to physical renovation and equipment acquisition costs. However, unlike the other alternatives, the 5-bed option did not require physical separation of the sub-unit and a subsequent decrease in sub-unit visibility. Reduction in sub-unit visibility had a significantly negative impact on the 4th floor.Analysis of the LDR and Postpartum sub-units showed that a combination of adding rooms and the LDRP alternative was the most effective way to mitigate capacity issues. Significant improvements were realized by implementing this change and adding five additional rooms to the unit. This alternative decreased the number of patients who experience wait times by 92% and decreased patient wait times by 72%. Unfortunately, the Women's & Children's Services did not have the ability to increase capacity in either of these sub-units at all. This restriction made the LDRP alternative the only one available for them to resolve capacity issues. Implementation of this plan will decrease the number of patients who experience wait times by 57% and decrease patient wait times by 49%. Conversion to LDRP rooms was less costly than increasing the overall capacity of the two sub-units separately. Additionally, less time was required to clean and maintain the rooms because patients will not require room transfer during their stay. This additional benefit serves to streamline processes on the 4th floor and will help the unit the meet patient demand