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Discrete-Event Simulation for Hospital Resource Planning: Possibilities and Requirements
Linköping University, Department of Science and Technology, Communications and Transport Systems. Linköping University, The Institute of Technology.
2010 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The delivery of health care services has been under pressure due to limited funding and increasing demand. This has highlighted the need to increase not only the effectiveness but also the efficiency of health care delivery. Discrete-event simulation has been suggested as an analysis tool in health care management to support the planning of health care resources.

The overall purpose of this thesis is to investigate the possibilities and requirements for using discrete-event simulation in analyzing and planning the use of hospital resources. This is achieved by three case studies that focus on improvements in patient flow of emergency patients that require a radiology examination, intensive care unit capacity planning and operating room allocation strategies, respectively.

The first case investigates the current stage of digitization and process orientation in hospital care as a prerequisite for efficient process simulation and analysis. The study reveals an emergency-radiology patient flow process that is not very well measured and uncovers disparate information systems storing incompatible and fragmented data. These results indicate that the current degree of process orientation and the current IT infrastructure does not enable efficient use of quantitative process analysis and management tools like simulation.

In the second case the possibilities to develop generic hospital unit simulation models by building and validating a generic intensive care unit (ICU) model are explored. The results show that some of the modeling approaches described in literature cannot replicate the actual behavior observed in all studied ICUs. It is important to identify patient groups for different admission priorities, to account for over-utilizations in the model logic, and to discover and properly model dependencies in the input data. The research shows that it is possible to develop a generic ICU simulation model that could realistically describe the performance of different real ICUs in terms of occupancy, coverage and transfers.

The value of simulation modeling in health care management is examined in the third case through the development and use of a simulation model for optimal resource allocation and patient flow in a hospital operating department. The goal of the simulation modeling in this case was to identify bottlenecks in the patient flow and to try different alternatives for allocation of operating room capacity in order to increase the utilization of operating room resources. The final model was used to evaluate four different proposed changes to operating room time allocation.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2010. , 25 p.
Series
Linköping Studies in Science and Technology. Thesis, ISSN 0280-7971 ; 1446
Keyword [en]
Discrete-event simulation (DES), health care, resource planning
National Category
Engineering and Technology
Identifiers
URN: urn:nbn:se:liu:diva-56556Local ID: LIU-TEK-LIC-2010:17ISBN: 978-91-7393-360-5 (print)OAI: oai:DiVA.org:liu-56556DiVA: diva2:320894
Presentation
2010-06-10, TP2, Täppan, Campus Norrköping., Linköpings universitet, Norrköping, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2010-06-14 Created: 2010-05-21 Last updated: 2010-06-14Bibliographically approved
List of papers
1. A modern process perspective, process mapping, and simulation in health care: Opportunities and IT infrastructural needs
Open this publication in new window or tab >>A modern process perspective, process mapping, and simulation in health care: Opportunities and IT infrastructural needs
2010 (English)In: Proceedings of 2010 IEEE Workshop on Health Care Management (WHCM), 2010, 1-6 p.Conference paper, Published paper (Refereed)
Abstract [en]

Today, health care organizations often claim that theyare “process oriented”, and that one should approach health carefrom a process perspective in order to utilize the present ITrelated benefits; such as increased service quality, cost efficiency,and enhanced communication. In this paper we investigate howwell founded the concept of process orientation really is – byexamining IT/IS infrastructures, and procedures for processdefinition, visualization, and evaluation – at a prominent hospitalin Stockholm, Sweden. A case study of the organization and theinteraction of the emergency and radiology departments at thesame hospital (using process mapping and data analysis) revealsdata fragmentation, incompatible data, and disparateinformation systems. This results in difficulties regarding processdefinition and analysis, which makes the use of innovative toolssuch as simulation, problematic. The implications of this, and thecontextual factors, are also discussed and some finalrecommendations for smooth digitization are put forth.Today, health care organizations often claim that theyare “process oriented”, and that one should approach health carefrom a process perspective in order to utilize the present ITrelated benefits; such as increased service quality, cost efficiency,and enhanced communication. In this paper we investigate howwell founded the concept of process orientation really is – byexamining IT/IS infrastructures, and procedures for processdefinition, visualization, and evaluation – at a prominent hospitalin Stockholm, Sweden. A case study of the organization and theinteraction of the emergency and radiology departments at thesame hospital (using process mapping and data analysis) revealsdata fragmentation, incompatible data, and disparateinformation systems. This results in difficulties regarding processdefinition and analysis, which makes the use of innovative toolssuch as simulation, problematic. The implications of this, and thecontextual factors, are also discussed and some finalrecommendations for smooth digitization are put forth.

Keyword
IT, digitization, process mapping, process orientation, data analysis, discrete event simulation (DES), health care.
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-56553 (URN)10.1109/WHCM.2010.5441276 (DOI)978-1-4244-4998-9 (ISBN)978-1-4244-4997-2 (ISBN)
Conference
IEEE Workshop on Health Care Management, February 18-20, Venice, Italy
Available from: 2010-05-21 Created: 2010-05-21 Last updated: 2017-08-14
2. Developing a Generic Simulation Model for Planning of Intensive Care Resource Needs
Open this publication in new window or tab >>Developing a Generic Simulation Model for Planning of Intensive Care Resource Needs
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The estimation of intensive care resource needs is often made on incomprehensive grounds as simple calculations fail to account for the complexity and variability in the patient flow. The aim of the study was to develop and validate a generic intensive care unit simulation model which could reproduce resource use, i.e. occupancy and coverage, as found in data from the Swedish Intensive Care Registry (SIR). The generic ICU model was developed using a stepwise modification and calibration approach in order to identify important parameters and their values to obtain a match between model predictions and actual data in four selected ICUs. The final version of the model included special logic for handling elective surgery patients, holding beds for dealing with overutilizations, and a mathematical model to describe admission rate dependency on actual occupancy. The results from model calibration indicate that simple models cannot adequately describe the behavior in all studied ICUs. It is necessary to include certain patient characteristics as well as to account properly for dependencies in input data in order to have the model predict ICU resource use as observed in historical data.

Keyword
Intensive care, discrete-event simulation, capacity planning, utilisation
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-56555 (URN)
Available from: 2010-05-21 Created: 2010-05-21 Last updated: 2010-06-14
3. Increasing Utilization in a Hospital Operating Department Using Simulation Modeling
Open this publication in new window or tab >>Increasing Utilization in a Hospital Operating Department Using Simulation Modeling
2010 (English)In: Simulation (San Diego, Calif.), ISSN 0037-5497, E-ISSN 1741-3133, Vol. 86, no 8-9, 463-480 p.Article in journal (Refereed) Published
Abstract [en]

This article focuses on the planning and scheduling of operating rooms (ORs) in a regional hospital in Sweden. A simulation study was carried out to find new ideas and new planning and scheduling techniques to improve the overall process of surgery, including pre- and post-operating activities. This study mainly addresses the problem of low utilization of the ORs, and also takes into consideration problems with variation in workload, both in ORs and in post-anesthesia care units. The final simulation model includes pre-operative care carried out in the operating department and all ORs, as well as post-operative care units. It was driven by a number of input parameters, such as the volume and specific characteristics of actual cases, opening hours and number of ORs, and the number of beds for pre- and post-operative care. The model also includes logic for prioritizing and allocating cases to available ORs, planning operating schedules and the utilization of medical equipment limited in quantity. Output performance measures from simulation experiments include the utilization of allocated OR times, waiting time for patients, queue dynamics, number of cancellations, and variation of finishing times, as well as occupancy statistics in the post-operative care unit. Four different change alternatives were evaluated using the simulation model. Simulation experiments showed that with the implementation of the proposed changes it is possible to achieve slightly better and more even resource utilization, as well as provide greater flexibility in scheduling operations.

Place, publisher, year, edition, pages
SAGE, 2010
Keyword
Healthcare, operating department, operating rooms, utilization, discrete-event simulation, planning, scheduling
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-56554 (URN)10.1177/0037549709359355 (DOI)000280765600002 ()
Available from: 2010-05-21 Created: 2010-05-21 Last updated: 2017-12-12

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