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Modeling and Analysis of the Emergency Department at University of Kentucky Chandler Hospital Using Simulations

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Introduction

In this article, we present a simulation study conducted in the emergency department at the University of Kentucky Chandler Hospital.

Methods

Based on analysis of process and flow data, a simulation model of patient throughput in the emergency department has been developed.

Results

What-if analyses have been proposed to identify bottlenecks and investigate the optimal numbers of human and equipment resources (eg, nurses, physicians, and radiology technology). The simulation results suggest that 3 additional nurses are needed to ensure desired clinical outcomes. Diagnostic testing, the computed tomography scan in particular, is found to be a bottleneck. As a result, acquisition of an additional computed tomography scanner is recommended. Hospital management has accepted the recommendations, and implementation is in progress.

Discussion

Such a model provides a quantitative tool for continuous improvement and process control in the emergency department and also is applicable to other departments in the hospital.

Section snippets

Flow Diagram

A diagram of patient flow in the UKCH emergency department has been formulated and is shown in Figure 1, where the squares are the bed/rooms in each department, the circles represent the routings or decisions, the rectangle is the waiting room, and the hexagon denotes triage desk.

Specifically, the following processes are typical for an ED patient visit:

  • Process 1: The triage nurse assigns acuity to arriving patients based on severity of the illness, such as life-threatening injuries/illness and

Results and Discussion

The simulation results are compared with the average throughput observed at UKCH emergency department. There is only a minimal difference between them (about 5%), which leads to validation of the model that will be used for subsequent analysis. Using the model, what-if analysis is carried out to study the sensitivity of system performance. These analyses evaluated different variables (such as number of doctors, nurses, and testing equipment) to determine optimal staffing and resource levels and

Conclusions

In this article, we present a simulation study of the UKCH emergency department. The simulation model can accurately emulate the patient flow in the emergency department. Using this model, we analyzed the effects of workforce configuration and resource utilizations in the UKCH emergency department. The optimal numbers of doctors, nurses, and testing equipments to achieve better quality of patient care service were investigated. It was shown that CT scanning is the system bottleneck. In

Stuart Brenner is Operations Management Leadership Program Engineer at GE Energy. At the time of this study, he was Graduate Student, Department of Electrical and Computer Engineering and Center for Manufacturing, University of Kentucky, Lexington, KY.

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Stuart Brenner is Operations Management Leadership Program Engineer at GE Energy. At the time of this study, he was Graduate Student, Department of Electrical and Computer Engineering and Center for Manufacturing, University of Kentucky, Lexington, KY.

Zhen Zeng is MDP Manufacturing Development Program Engineer at Cummins Inc. At the time of this study, she was Graduate Student, Department of Electrical and Computer Engineering and Center for Manufacturing, University of Kentucky, Lexington, KY.

Yang Liu is PhD candidate, Department of Electrical and Computer Engineering and Center for Manufacturing, University of Kentucky, Lexington, KY.

Junwen Wang is PhD candidate, Department of Electrical and Computer Engineering and Center for Manufacturing, University of Kentucky, Lexington, KY.

Jingshan Li is Assistant Professor of Electrical and Computer Engineering, Department of Electrical and Computer Engineering and Center for Manufacturing, University of Kentucky, Lexington, KY.

Patricia K. Howard is Operation Manager, Trauma and Emergency Services, University of Kentucky Chandler Medical Center, Lexington, KY.

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