WSC 2003 Final Abstracts

Emergency Management: Capability Analysis of Critical Incident Response
Thomas F. Brady (Purdue University North Central)

Abstract:
Since 9/11, homeland security efforts and the readiness of emergency management agencies have become focal points in the war on terrorism. A significant issue faced by front line responders has been the explosion of potential incidents they must be prepared to handle. This paper describes a simulation-based approach that allows county emergency management agencies to more quickly develop, test, and refine plans for an ever increasing list of potential threats. The focus of the modeling environment is the information flow, coordination, and response times for medical, police, and fire resources.

Computer Simulation of a Mobile Examination Center
Vera Z. Osidach and Michael C. Fu (University of Maryland)

Abstract:
The National Health and Nutrition Examination Survey (NHANES), sponsored by the United States Centers for Disease Control and Prevention (CDC), uses large custom-built Mobile Examination Centers (MECs) to gather confidential data on the residential population of the United States. The data are used to generate national statistics and standards on health and nutrition for the nation. CDC is also exploring a community-based health examination survey designed to produce health statistics for smaller areas or defined populations, tentatively called the Community Health and Nutrition Examination Survey (CHANES), which would consist of a smaller self-contained MEC. In this paper, we describe a CHANES MEC simulation model built based on actual field data. The model is used to demonstrate how layout and staffing decisions could be evaluated for benefit/cost tradeoff analysis.

Proposals to Reduce Over-Crowding, Lengthy Stays and Improve Patient Care: Study of the Geriatric Department in Norway’s Largest Hospital
Eleazer Martin and Roar Grønhaug (BestSys) and Kristin Haugene (Ullevaal University Hospital)

Abstract:
Changes in demographics and the burgeoning costs of medical care are putting hospitals in all developed countries under increased pressure. This paper will demonstrate how simulation is contributing to satisfying stakeholders demands for increased efficiency and rates of return as well as improving the potential for geriatric patients reconvalescence and reducing the number of ‘corridor beds’. Although considered a fire hazard and therefore illegal, corridor beds are a common phenomenon in Norway. The four main issues to be discussed are: Clinical pathways, the unmet demand for geriatric care at the hospital, the potential for increasing patient throughput at the geriatric ward and ways to achieve it.

A Methodology for Modeling Front Office and Patient Care Processes in Ambulatory Health Care
Bradley P. Morrison (Cost Control) and Barbara C. Bird (Bird Consulting Group, Inc.)

Abstract:
Although discrete event simulation has made significant progress in the health care field, it has been tested primarily in hospitals and specialty clinics. Our mission was to assess the effectiveness and economics of simulation in free standing ambulatory health care settings. Our findings to date indicate a good fit of simulation tools for the objective of total business process improvement. In addition to the simulation tools, we used other hardware and software solutions to meet the special needs of small businesses such as small health care providers. Critical success factors for the project were visual mapping and simulation tools, extensive energy and time in process and resource mapping, data collection methods, technologies that minimize on-site time for client and consultant, and the importance of having a clinical healthcare professional on the consultant team. The techniques detailed in this paper can be applied to diverse simulation projects for effective results.

The use of Simulation to Evaluate Hospital Operations between the Emergency Department and a Medical Telemetry Unit
Ruby E. Blasak (Rush North Shore Medical Center), Wendy S. Armel and Darrell W. Starks (Rockwell Automation) and Mary C. Hayduk (Cap Gemini Ernst & Young)

Abstract:
This paper presents a simulation model of the operations in the Emergency Department (ED) and Medical Telemetry (Med Tele) Units at Rush North Shore Medical Center. The model allows management to see the operations of both units as well as how the processes of each unit impact the other. Due to the large amount of variability that can take place within these units, Rush North Shore Medical Center along with Cap Gemini Ernst & Young sought the use of simulation to help evaluate their operations and provide insight into possible areas for improvement. Rockwell Automation created a model which depicts the current operations and evaluates possible alternatives to reduce the length of stay in the ED and improve operations. Using simulation, the hospital was able to select two to three key changes, rather than creating more stress with ten or more changes, to get the same result.

Redesigning the Medication Ordering, Dispensing, and Administration Process in an Acute Care Academic Health Science Centre
Cathy Wong, Glen Geiger, and Yaron D. Derman (Sunnybrook & Women's Health Sciences Centre) and Carolyn R. Busby and Michael W. Carter (University of Toronto)

Abstract:
Two simulation models have been built to quantify the advantages of an electronic medication ordering, dispensing and administration process compared with the current manual process at an acute care academic health sciences center. The first model represents the current manual system, and has been validated against observed data. The second model represents the proposed electronic medication ordering, dispensing and administration system. The results show that there is a potential to significantly reduce the overall turnaround time (from the initiation of the order to the delivery of the medication to the wards) from 256 minutes to less than 123 minutes, a reduction in the pharmacokinetic failures from 16.3% to less than 5.7%, and a reduction in tight failures from 65.5% to less than 14.5%; thus improving the rate of first doses of medications that are delivered in time to be administered.

The use of Simulation and Design of Experiments for Estimating Maximum Capacity in an Emergency Room
Felipe F. Baesler and Hector Jahnsen (Universidad del Bio-Bio) and Mahal DaCosta (Universidad de Concepción)

Abstract:
This work presents the results obtained after using a simulation model for estimating the maximum possible demand increment in an emergency room of a private hospital in Chile. To achieve this objective the first step was to create a simulation model of the system under study. This model was used to create a curve for predicting the behavior of the variable patient’s time in system and estimate the maximum possible demand that the system can absorb. Finally, a design of experiments was conducted in order to define the minimum number of physical and human resources required to serve this demand.

The use of Simulation to Reduce the Length of Stay in an Emergency Department
Simon Samaha (The Cooper Health System) and Wendy S. Armel and Darrell W. Starks (Rockwell Automation)

Abstract:
This paper presents a simulation model of the operations in the Emergency Department (ED) at The Cooper Health System. Due to the large amount of variability that can take place within an ED, Cooper Health System sought the use of simulation to help evaluate their operations and possible solutions to their problems. The objective of the model was for Rockwell Automation to create a model which depicts the current operations and evaluate possible alternatives to reduce the length of stay. For construction of the model, data was gathered 24 hours a day over a seven-day period. Every operation performed in the ED was evaluated. The model has yielded results that have saved the hospital considerable time as well as helped to avoid tremendous costs.

Using Simulation in the Architectural Concept Phase of an Emergency Department Design
Allan Wiinamaki (Sarasota Memorial Hospital) and Rainer Dronzek (Simulation Modeling Services, LLC)

Abstract:
This paper describes an emergency care center simulation (ECC) project at Sarasota Memorial Hospital in Sarasota, Florida. The objective was to project bed requirements for an emergency care center expansion. The project team also analyzed the impact on downstream departments that are an integral part of the ECC. The simulation model was developed at a macro level and targeted the capacity requirements based on length of stay for each of the patient areas affected by the expansion. This macro-level model, used for the architectural concept phase, was designed to allow for enhancement into a micro-level model to analyze the detailed processes of the ECC once the basic concepts of layout, number of rooms and beds, and hours of operations were established.

Pairing Emergency Severity Index5-Level Triage Data with Computer Aided System Design to Improve Emergency Department Access and Throughput
S. Mahapatra, C. P. Koelling, L. Patvivatsiri, and B. Fraticelli (Virginia Tech) and D. Eitel and L. Grove (York Hospital)

Abstract:
Patient waiting times and service quality problems characterize emergency departments worldwide. The purpose of this research is to develop a reliable decision support system using the Emergency Severity Index (ESI©) triage method to drive improvements in the care delivery process, as part of a hospital Emergency Care Delivery System. Models were developed using first a relatively low fidelity software, ProcessModel, and then in Arena, a relatively high fidelity simulation software, to test new proposals for service delivery improvements in an academic ED in York Hospital, Pennsylvania, where the ESI© triage system has been implemented. This paper pairs the case mix derived from ESI© triage with simulation to support resource deployment to improve service metrics and support strategic decision making in academic EDs. The lessons learned could be reanalyzed in a simulation model more representative of a non-academic (regular hospital) ED that implements ESI© five level triage.

Simulating Six Sigma Improvement Ideas for a Hospital Emergency Department
Martin J. Miller and David M. Ferrin (Business Prototyping Inc.) and Jill M. Szymanski (Baptist Health South Florida)

Abstract:
A large hospital in the southeast United States utilized simulation to aid project leaders in advancing to the next level of sophistication with Six Sigma. The project produced an ongoing, workable model from which to simulate potential process improvements in their Emergency Department (ED). Project leaders tested several scenarios in the ED Simulation to quantify their value proposition. The simulation model also enabled the hospital to test design ideas of a planned new facility.

A Simulation-ILP based Tool for Scheduling ER Staff
Martha A. Centeno, Ronald Giachetti, and Richard Linn (Florida International University) and Abdullah M. Ismail (Baptist Health South Hospital)

Abstract:
Healthcare facilities, especially hospitals, are under financial pressure to control cost. One element that affects cost significantly is staff. We have developed a tool that integrates a simulation model and an integer linear program (ILP). The simulation model establishes the staffing requirements for each period, and the ILP produces an optimal calendar schedule for the staff, i.e. how many staff members to start at each shift. The two models were fully integrated, under a Visual Basic interface that allowed a non expert user of the heuristic to interact with it on a repetitive planning basis.