Skip to main content
SpringerLink
Log in

A Hybrid Simulation Approach to Analyse Patient Boarding in Emergency Departments

  • Conference paper
  • First Online:
Health Care Systems Engineering (ICHCSE 2017)

Part of the book series: Springer Proceedings in Mathematics & Statistics ((PROMS,volume 210))

Included in the following conference series:

Abstract

This paper deals with the problem of patient boarding in Emergency Department (ED) due to the lack of availability of stay beds in inpatient hospital wards. The boarding of emergent patients is a major reason of ED overcrowding, which in turn creates long waiting times in ED, as well as patient and staff dissatisfaction. In this paper a hybrid simulation framework is proposed to describe how emergent and elective patients flows interact each other inside the hospital. The framework combines System Dynamics (SD) and Discrete Event Simulation (DES). Flows are generated at macro level by the SD model, while in DES model they are disentangled into single entities following a detailed process-oriented pathway. The hybrid model has been then applied and validated to data from a medium-size public hospital located in Genova (Italy). Furthermore, some metrics (such as waiting times to be admitted in hospital, number of trolleys in ED, inpatient bed occupancy rates and elective patients delayed) are proposed as key indicators to assess the system performance.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Abdelghany, M., Eltawil, A.B., Abdou, S.F.: A discrete-event and agent-based hybrid simulation approach for healthcare systems modelling and analysis. In: IEOM Society International (eds.) Proceedings of the 2016 International Conference on Industrial Engineering and Operations Management, pp. 1921–1928 (2016)

    Google Scholar 

  2. Abo-Hamad, W., Arisha, A.: Simulation-based framework to improve patient experience in an emergency department. Eur. J. Oper. Res. 224(1), 154–166 (2013)

    Article  Google Scholar 

  3. Aboueljinane, L., Sahin, E., Jemai, Z.: A review on simulation models applied to emergency medical service operations. Comput. Ind. Eng. 66, 734–750 (2013)

    Article  Google Scholar 

  4. Anagnostou, A., Nouman, A., Taylor, S.J.E.: Distributed hybrid agent based discrete event emergency medical services simulation. In: Proceedings of the 2013 Winter Simulation Conference: Simulation: Making Decisions in a Complex World, pp. 1625–1636 (2013)

    Google Scholar 

  5. Bagust, A., Place, M., Posnett, J.: Dynamics of bed use in accommodating emergency admissions: stochastic simulation model. BMJ 310(7203), 155–158 (1999)

    Article  Google Scholar 

  6. Brailsford, S., Churilov, L., Dangerfield, B.: Discrete-Event Simulation and System Dynamics for Management Decision Making. Wiley (2014)

    Google Scholar 

  7. Brailsford, S.C.: System dynamics: what in it for healthcare simulation modelers. In Mason, S.J., Hill, R.R., Mönch, L., Rose, O., Jefferson, T., Fowler, J.W. (eds.) Proceedings of the 2008 Winter Simulation Conference, Piscataway, New Jersey, USA (2008)

    Google Scholar 

  8. Brailsford, S.C.: Hybrid simulation in healthcare: new concepts and new tools. In: Yilmaz, L., Chan, W.K.V., Moon, I., Roeder, T.M.K., Macal, C., Rossetti, M.D. (eds.) Proceedings of the 2015 Winter Simulation Conference, pp. 1645–1653, Piscataway, New Jersey, USA (2015)

    Google Scholar 

  9. Brailsford, S.C., Desai, S.M., Viana, J.: Towards the Holy Grail: combining system dynamics and discrete-event simulation in healthcare. In: Johansson, B., Jain, S., Montoya-Torres, J., Hugan, J., Yucesan, E. (eds.) Proceedings of the 2010 Winter Simulation Conference, pp. 2293–2303, Baltimore, Maryland, USA (2010)

    Google Scholar 

  10. Chahal, K., Eldabi, T.: Applicability of hybrid simulation to different models of governance in UK healthcare. In: Mason, S.J., Hill, R.R., Monch, L., Rose, O., Jefferson, T., Fowler, J.W. (eds.) Proceedings of the 2008 Winter Simulation Conference, pp. 1469–1477, Miami, Florida, USA (2008)

    Google Scholar 

  11. Duguay, C., Chetouane, F.: Modeling and improving emergency department systems using discrete event simulation. Simulation 83(4), 311–320 (2007)

    Article  Google Scholar 

  12. Fakhimi, M., Mustafee, N.: An investigation of hybrid simulation for modelling sustainability in healthcare. In: Proceedings of the 2015 Winter Simulation Conference (2015)

    Google Scholar 

  13. Gül, M., Guneri, A.F.: A comprehensive review of emergency department simulation applications for normal and disaster conditions. Comput. Ind. Eng. 83(5), 327–344 (2015)

    Article  Google Scholar 

  14. Gunal, M.M., Pidd, M.: Discrete event simulation for performance modelling in health care: a review of the literature. J. Simul. 4, 42–51 (2010)

    Article  Google Scholar 

  15. Heath, S.K., Brailsford, S.C., Buss, A., Macal, C.M.: Cross-paradigm simulation modeling: challenges and successes. In: Proceedings of the 2011 Winter Simulation Conference, pp. 2788–2802 (2011)

    Google Scholar 

  16. Katsaliaki, K., Mustafee, N.: Applications of simulation within the healthcare context. J. Oper. Res. Soc. 62(8), 1431–1451 (2010)

    Article  Google Scholar 

  17. Kausshal, A., Zhao, Y., Peng, Q., Strome, T., Weldon, E., Zhang, M., Chochinov, A.: Evaluation of fast track strategies using agent-based simulation modeling to reduce waiting time in a hospital emergency department. Socioecon. Plann. Sci. 50, 18–31 (2015)

    Article  Google Scholar 

  18. Landa, P., Sonnessa, M., Tànfani, E., Testi, A.: Managing emergent patient flow to inpatient wards: a discrete event simulation approach. In: Obaidat, M.S., Ören, T., Kacprzyk, J., Filipe, J. (eds.)Advances in Intelligent Systems and Computing, Chapter 17, pp. 333–350. Springer (2016a)

    Google Scholar 

  19. Landa, P., Sonnessa, M., Tànfani, E., Testi, A.: System dynamics modelling of emergent and elective patient flows. In: Matta, A., Li, J., Vandaele, N.J., Guinet, A., Sahin, E. (eds.) Springer Proceedings in Mathematics and Statistics. Springer, New York (2016)

    Google Scholar 

  20. Lane, D.C., Monefeldt, C., Rosenhead, J.V.: Looking in the wrong place for healthcare improvements: a system dynamics study of an accident and emergency department. J. Oper. Res. Soc. 51, 518–531 (2000)

    Article  MATH  Google Scholar 

  21. Paul, J.A., Lin, L.: Models for improving patient throughput and waiting at hospital emergency departments. J. Emerg. Med. 43(6), 1119–1126 (2012)

    Article  Google Scholar 

  22. Proudlove, N.C., Black, S., Fletcher, A.: OR and the challenge to improve the NHS: modelling for insight and improvement in in-patient flows. J. Oper. Res. Soc. 58, 145–158 (2007)

    Article  MATH  Google Scholar 

  23. Vanderby, S., Carter, M.W.: An evaluation of the applicability of system dynamics to patient flow modelling. J. Oper. Res. Soc. 61, 1572–1581 (2010)

    Article  Google Scholar 

  24. Viana, J., Brailsford, S.C., Harindra, V., Harper, P.R.: Combining discrete-event simulation and system dynamics in healthcare setting: a composite model for Chlamydia infection. Eur. J. Oper. Res. 237(1), 196–206 (2014)

    Article  Google Scholar 

  25. Wong, H.J., Morra, D., Wu, R.C., Caesar, M., Abrams, H.: Using system dynamics principles for conceptual modelling of publicly funded hospitals. J. Oper. Res. Soc. 63(1), 79–88 (2012)

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medical School, University of Exeter, Exeter, UK

    Paolo Landa

  2. Department of Economics and Business Studies, University of Genova, Genoa, Italy

    Michele Sonnessa, Marina Resta, Elena Tànfani & Angela Testi

Authors
  1. Paolo Landa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michele Sonnessa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marina Resta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elena Tànfani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Angela Testi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michele Sonnessa .

Editor information

Editors and Affiliations

  1. Dipartimento di Ingegneria dell’Informazione, University of Florence, Florence, Italy

    Paola Cappanera

  2. Department of Industrial and Systems Engineering, University of Wisconsin–Madison, Madison, Wisconsin, USA

    Jingshan Li

  3. Department of Mechanical Engineering, Politecnico di Milano, Milan, Italy

    Andrea Matta

  4. Laboratoire Génie Industriel, École Centrale Paris, Châtenay-Malabry, France

    Evren Sahin

  5. OG Productie en Logistiek Leuven, Katholieke Universiteit Leuven, Leuven, Belgium

    Nico J. Vandaele

  6. Dipartimento di Ingegneria Industriale, University of Florence, Florence, Italy

    Filippo Visintin

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this paper

Check for updates. Verify currency and authenticity via CrossMark

Cite this paper

Landa, P., Sonnessa, M., Resta, M., Tànfani, E., Testi, A. (2017). A Hybrid Simulation Approach to Analyse Patient Boarding in Emergency Departments. In: Cappanera, P., Li, J., Matta, A., Sahin, E., Vandaele, N., Visintin, F. (eds) Health Care Systems Engineering. ICHCSE 2017. Springer Proceedings in Mathematics & Statistics, vol 210. Springer, Cham. https://doi.org/10.1007/978-3-319-66146-9_12

Download citation

Publish with us

Policies and ethics

Search

Navigation