Research Article
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Changing the Patient Flow Process for the Green Area of Emergency Department: A Discrete-Event Simulation Approach

Year 2024, Volume: 9 Issue: 1, 45 - 63, 27.03.2024

Abstract

Aim: This study aimed to analyze patient waiting times and hospital stay times by developing a different approach to the current patient flow processes in the green area of a hospital emergency
department.
Methods: Numerical and statistical results were obtained using a discrete event simulation model for the current and new situation of patient flow processes.
Results: The waiting time decreased from 12.91 minutes in the current simulation model to 12.81 minutes in the proposed simulation model. The length of stay time decreased from 54.72 minutes in the current simulation model to 53.90 minutes in the proposed simulation model. In this case, it is seen that the proposed model provides a reduction in the length of stay and patient waiting time.
Conclusion: The result shows that the proposed model provides some improvement in both waiting and length of stay time. This study offers a different approach to patient flow, allowing emergency department personnel to use their resources effectively and minimizing the time spent on patients' treatment or waiting periods. Thus, this study concluded that the effective management of recommended patient flow processes increases the capacity of emergency departments to deal with emergencies and accelerates access to emergency medical services.

References

  • Ahmed, Mohamed A, and Talal M Alkhamis. 2009. “Simulation Optimization for an Emergency Department Healthcare Unit in Kuwait.” European Journal of Operational Research 198 (3): 936–42.
  • Alowad, Ali, Premaratne Samaranayake, Kazi Ahsan, Hisham Alidrisi, and Azharul Karim. 2021. “Enhancing Patient Flow in Emergency Department (ED) Using Lean Strategies–an Integrated Voice of Customer and Voice of Process Perspective.” Business Process Management Journal 27 (1): 75–105.
  • Atalan, Abdulkadir. 2021. “Analysis of Patient Flow Diagram Structure in Health Management.” In 7th International Conference on Social Sciences & Humanities, 17–23.
  • Atalan, Abdulkadir. 2021. “Effect of Healthcare Expenditure on the Correlation Between the Number of Nurses and Doctors Employed.” International Journal of Health Management and Tourism 6 (2): 515–25. https://doi.org/10.31201/ijhmt.949500.
  • Atalan, Abdulkadir. 2022. “A Cost Analysis with the Discrete‐event Simulation Application in Nurse and Doctor Employment Management.” Journal of Nursing Management 30 (3): 733–41. https://doi.org/10.1111/jonm.13547.
  • Atalan, Abdulkadir, and Cem Cağrı Dönmez. 2020. “Optimizing Experimental Simulation Design for the Emergency Departments.” Brazilian Journal of Operations & Production Management 17 (4): 1–13. https://doi.org/10.14488/BJOPM.2020.026.
  • Atalan, Abdulkadir, Cem Çağrı Dönmez, and Yasemin Ayaz Atalan. 2018. “Yüksek-Eğitimli Uzman Hemşire İstihdamı Ile Acil Servis Kalitesinin Yükseltilmesi Için Simülasyon Uygulaması: Türkiye Sağlık Sistemi.” Marmara Fen Bilimleri Dergisi 30 (4): 318–38. https://doi.org/10.7240/marufbd.395255.
  • Berg, Bjorn, Brian Denton, Heidi Nelson, Hari Balasubramanian, Ahmed Rahman, Angela Bailey, and Keith Lindor. 2010. “A Discrete Event Simulation Model to Evaluate Operational Performance of a Colonoscopy Suite.” Medical Decision Making 30 (3): 380–87. https://doi.org/10.1177/0272989X09345890.
  • Chang, Kuo-Hao, Tzu-Li Chen, Fu-Hao Yang, and Tzu-Yin Chang. 2023. “Simulation Optimization for Stochastic Casualty Collection Point Location and Resource Allocation Problem in a Mass Casualty Incident.” European Journal of Operational Research 309 (3): 1237–62.
  • Clarke, A. 2001. “Length of Stay: How Short Should Hospital Care Be?” The European Journal of Public Health 11 (2): 166–70. https://doi.org/10.1093/eurpub/11.2.166.
  • Dönmez, Nergis Feride Kaplan, Abdulkadir Atalan, and Cem Çağrı Dönmez. 2020. “Desirability Optimization Models to Create the Global Healthcare Competitiveness Index.” Arabian Journal for Science and Engineering 45 (8): 7065–76. https://doi.org/10.1007/s13369-020 04718-w.
  • Fagbuyi, Daniel B., Kathleen M. Brown, David J. Mathison, Jennifer Kingsnorth, Sephora Morrison, Mohsen Saidinejad, Jeff Greenberg, Michael Knapp, and James M. Chamberlain. 2011. “A Rapid Medical Screening Process Improves Emergency Department Patient Flow During Surge Associated With Novel H1N1 Influenza Virus.” Annals of Emergency Medicine 57 (1): 52–59. https://doi.org/10.1016/j.annemergmed.2010.08.026.
  • Gharahi, A, A H Kheirkhah, A Bagheri, and M Ahmadi. 2014. “Improving Patient Flow Management Process in Emergency Department Using Simulation and PROMETHEE Method.” Journal of Health Administration (JHA) 17 (57): Pe11–25.
  • Gualandi, Raffaella, Cristina Masella, and Daniela Tartaglini. 2020. “Improving Hospital Patient Flow: A Systematic Review.” Business Process Management Journal 26 (6): 1541–75.
  • Hanne, Thomas, Teresa Melo, and Stefan Nickel. 2009. “Bringing Robustness to Patient Flow Management Through Optimized Patient Transports in Hospitals.” Interfaces 39 (3): 241–55. https://doi.org/10.1287/inte.1080.0379.
  • Holroyd, Brian R., Michael J. Bullard, Karen Latoszek, Debbie Gordon, Sheri Allen, Siulin Tam, Sandra Blitz, Philip Yoon, and Brian H. Rowe. 2007. “Impact of a Triage Liaison Physician on Emergency Department Overcrowding and Throughput: A Randomized Controlled Trial.” Academic Emergency Medicine 14 (8): 702–8. https://doi.org/10.1197/j.aem.2007.04.018.
  • Hoot, Nathan R., Larry J. LeBlanc, Ian Jones, Scott R. Levin, Chuan Zhou, Cynthia S. Gadd, and Dominik Aronsky. 2008. “Forecasting Emergency Department Crowding: A Discrete Event Simulation.” Annals of https://doi.org/10.1016/j.annemergmed.2007.12.011. Emergency Medicine.
  • Hugelius, Karin, Julia Becker, and Annsofie Adolfsson. 2020. “Five Challenges When Managing Mass Casualty or Disaster Situations: A Review Study.” International Journal of Environmental Research and Public Health 17 (9): 3068.
  • Jarvis, Paul Richard Edwin. 2016. “Improving Emergency Department Patient Flow.” Clinical and Experimental Emergency Medicine 3 (2): 63–68. https://doi.org/10.15441/ceem.16.127.
  • Johnson, Mark, Nicola Burgess, and Simon Sethi. 2020. “Temporal Pacing of Outcomes for Improving Patient Flow: Design Science Research in a National Health Service Hospital.” Journal of Operations Management 66 (1–2): 35–53. https://doi.org/10.1002/joom.1077. Kelen, Gabor D, Richard Wolfe, Gail D’Onofrio, Angela M Mills, Deborah Diercks, Susan A Stern,
  • Michael C Wadman, and Peter E Sokolove. 2021. “Emergency Department Crowding: The Canary in the Health Care System.” NEJM Catalyst Innovations in Care Delivery 2 (5).
  • Khan, Yasmin, Tracey O’Sullivan, Adalsteinn Brown, Shannon Tracey, Jennifer Gibson, Mélissa Généreux, Bonnie Henry, and Brian Schwartz. 2018. “Public Health Emergency Preparedness: A Framework to Promote Resilience.” BMC Public Health 18: 1–16. Konrad, Renata, Kristine DeSotto, Allison Grocela, Patrick McAuley, Justin Wang, Jill Lyons, and
  • Michael Bruin. 2013. “Modeling the Impact of Changing Patient Flow Processes in an Emergency Department: Insights from a Computer Simulation Study.” Operations Research for Health Care 2 (4): 66–74. https://doi.org/https://doi.org/10.1016/j.orhc.2013.04.001.
  • Lovett, Paris B., Megan L. Illg, and Brian E. Sweeney. 2016. “A Successful Model for a Comprehensive Patient Flow Management Center at an Academic Health System.” American Journal of Medical Quality 31 (3): 246–55. https://doi.org/10.1177/1062860614564618.
  • Mahmud, Ehtisham, Harold L Dauerman, Frederick G P Welt, John C Messenger, Sunil V Rao, Cindy Grines, Amal Mattu, Ajay J Kirtane, Rajiv Jauhar, and Perwaiz Meraj. 2020. “Management of Acute Myocardial Infarction during the COVID-19 Pandemic: A Position Statement from the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicia.” Journal of the American College of Cardiology 76 (11): 1375–84.
  • McIntyre, Daniel, and Clara K Chow. 2020. “Waiting Time as an Indicator for Health Services under Strain: A Narrative Review.” INQUIRY: The Journal of Health Care Organization, Provision, and Financing 57: 0046958020910305.
  • Mercer, Mary P., Malini K. Singh, and Hemal K. Kanzaria. 2019. “Reducing Emergency Department Length of Stay.” JAMA 321 (14): 1402. https://doi.org/10.1001/jama.2018.21812.
  • Molnar, Alex D. 2023. “Using Simulation in Healthcare Emergency Transport to Improve Efficiency and Safety.” Ohio University. Murphy, Peter, Paresh Wankhade, and Katarzyna Lakoma. 2020. “The Strategic and Operational Landscape of Emergency Services in the UK.” International Journal of Emergency Services 9 (1): 69–88. Nugus, Peter, Anna Holdgate, Margaret Fry, Roberto Forero, Sally McCarthy, and Jeffrey
  • Braithwaite. 2011. “Work Pressure and Patient Flow Management in the Emergency Department: Findings From an Ethnographic Study.” Academic Emergency Medicine 18 (10): 1045–52. https://doi.org/10.1111/j.1553-2712.2011.01171.x.
  • Ouda, Eman, Andrei Sleptchenko, and Mecit Can Emre Simsekler. 2023. “Comprehensive Review and Future Research Agenda on Discrete-Event Simulation and Agent-Based Simulation of Emergency Departments.” Simulation Modelling Practice and Theory, 102823.
  • Pak, Anton, Brenda Gannon, and Andrew Staib. 2021. “Predicting Waiting Time to Treatment for Emergency Department Patients.” International Journal of Medical Informatics 145 (January): 104303. https://doi.org/10.1016/j.ijmedinf.2020.104303.
  • Rau, Chi-Lun, Pei-Fang Jennifer Tsai, Sheau-Farn Max Liang, Jhih-Cian Tan, Hong-Cheng Syu, Yue-Ling Jheng, Ting-Syuan Ciou, and Fu-Shan Jaw. 2013. “Using Discrete-Event Simulation in Strategic Capacity Planning for an Outpatient Physical Therapy Service.” Health Care Management Science 16 (4): 352–65. https://doi.org/10.1007/s10729-013-9234 2.
  • Saghafian, Soroush, Garrett Austin, and Stephen J Traub. 2015. “Operations Research/Management Contributions to Emergency Department Patient Flow Optimization: Review and Research Prospects.” IIE Transactions on Healthcare Systems Engineering 5 (2): 101–23.
  • Scanlon, Joseph, Ira Helsloot, and Jelle Groenendaal. 2014. “Putting It All Together: Integrating Ordinary People into Emergency Response.” International Journal of Mass Emergencies & Disasters 32 (1): 43–63.
  • Ung, Carolina Oi Lam. 2020. “Community Pharmacist in Public Health Emergencies: Quick to Action against the Coronavirus 2019-NCoV Outbreak.” Research in Social and Administrative Pharmacy 16 (4): 583–86.
  • Vázquez-Serrano, Jesús Isaac, Leopoldo Eduardo Cárdenas-Barrón, Julio C Vicencio-Ortiz, Timothy Matis, Carlos Martín Gaitán-Mercado, and Rodrigo E Peimbert-García. 2024. “Hybrid Optimization and Discrete-Event Simulation Model to Reduce Waiting Times in a Primary Health Center.” Expert Systems with Applications 238: 121920.
Year 2024, Volume: 9 Issue: 1, 45 - 63, 27.03.2024

Abstract

References

  • Ahmed, Mohamed A, and Talal M Alkhamis. 2009. “Simulation Optimization for an Emergency Department Healthcare Unit in Kuwait.” European Journal of Operational Research 198 (3): 936–42.
  • Alowad, Ali, Premaratne Samaranayake, Kazi Ahsan, Hisham Alidrisi, and Azharul Karim. 2021. “Enhancing Patient Flow in Emergency Department (ED) Using Lean Strategies–an Integrated Voice of Customer and Voice of Process Perspective.” Business Process Management Journal 27 (1): 75–105.
  • Atalan, Abdulkadir. 2021. “Analysis of Patient Flow Diagram Structure in Health Management.” In 7th International Conference on Social Sciences & Humanities, 17–23.
  • Atalan, Abdulkadir. 2021. “Effect of Healthcare Expenditure on the Correlation Between the Number of Nurses and Doctors Employed.” International Journal of Health Management and Tourism 6 (2): 515–25. https://doi.org/10.31201/ijhmt.949500.
  • Atalan, Abdulkadir. 2022. “A Cost Analysis with the Discrete‐event Simulation Application in Nurse and Doctor Employment Management.” Journal of Nursing Management 30 (3): 733–41. https://doi.org/10.1111/jonm.13547.
  • Atalan, Abdulkadir, and Cem Cağrı Dönmez. 2020. “Optimizing Experimental Simulation Design for the Emergency Departments.” Brazilian Journal of Operations & Production Management 17 (4): 1–13. https://doi.org/10.14488/BJOPM.2020.026.
  • Atalan, Abdulkadir, Cem Çağrı Dönmez, and Yasemin Ayaz Atalan. 2018. “Yüksek-Eğitimli Uzman Hemşire İstihdamı Ile Acil Servis Kalitesinin Yükseltilmesi Için Simülasyon Uygulaması: Türkiye Sağlık Sistemi.” Marmara Fen Bilimleri Dergisi 30 (4): 318–38. https://doi.org/10.7240/marufbd.395255.
  • Berg, Bjorn, Brian Denton, Heidi Nelson, Hari Balasubramanian, Ahmed Rahman, Angela Bailey, and Keith Lindor. 2010. “A Discrete Event Simulation Model to Evaluate Operational Performance of a Colonoscopy Suite.” Medical Decision Making 30 (3): 380–87. https://doi.org/10.1177/0272989X09345890.
  • Chang, Kuo-Hao, Tzu-Li Chen, Fu-Hao Yang, and Tzu-Yin Chang. 2023. “Simulation Optimization for Stochastic Casualty Collection Point Location and Resource Allocation Problem in a Mass Casualty Incident.” European Journal of Operational Research 309 (3): 1237–62.
  • Clarke, A. 2001. “Length of Stay: How Short Should Hospital Care Be?” The European Journal of Public Health 11 (2): 166–70. https://doi.org/10.1093/eurpub/11.2.166.
  • Dönmez, Nergis Feride Kaplan, Abdulkadir Atalan, and Cem Çağrı Dönmez. 2020. “Desirability Optimization Models to Create the Global Healthcare Competitiveness Index.” Arabian Journal for Science and Engineering 45 (8): 7065–76. https://doi.org/10.1007/s13369-020 04718-w.
  • Fagbuyi, Daniel B., Kathleen M. Brown, David J. Mathison, Jennifer Kingsnorth, Sephora Morrison, Mohsen Saidinejad, Jeff Greenberg, Michael Knapp, and James M. Chamberlain. 2011. “A Rapid Medical Screening Process Improves Emergency Department Patient Flow During Surge Associated With Novel H1N1 Influenza Virus.” Annals of Emergency Medicine 57 (1): 52–59. https://doi.org/10.1016/j.annemergmed.2010.08.026.
  • Gharahi, A, A H Kheirkhah, A Bagheri, and M Ahmadi. 2014. “Improving Patient Flow Management Process in Emergency Department Using Simulation and PROMETHEE Method.” Journal of Health Administration (JHA) 17 (57): Pe11–25.
  • Gualandi, Raffaella, Cristina Masella, and Daniela Tartaglini. 2020. “Improving Hospital Patient Flow: A Systematic Review.” Business Process Management Journal 26 (6): 1541–75.
  • Hanne, Thomas, Teresa Melo, and Stefan Nickel. 2009. “Bringing Robustness to Patient Flow Management Through Optimized Patient Transports in Hospitals.” Interfaces 39 (3): 241–55. https://doi.org/10.1287/inte.1080.0379.
  • Holroyd, Brian R., Michael J. Bullard, Karen Latoszek, Debbie Gordon, Sheri Allen, Siulin Tam, Sandra Blitz, Philip Yoon, and Brian H. Rowe. 2007. “Impact of a Triage Liaison Physician on Emergency Department Overcrowding and Throughput: A Randomized Controlled Trial.” Academic Emergency Medicine 14 (8): 702–8. https://doi.org/10.1197/j.aem.2007.04.018.
  • Hoot, Nathan R., Larry J. LeBlanc, Ian Jones, Scott R. Levin, Chuan Zhou, Cynthia S. Gadd, and Dominik Aronsky. 2008. “Forecasting Emergency Department Crowding: A Discrete Event Simulation.” Annals of https://doi.org/10.1016/j.annemergmed.2007.12.011. Emergency Medicine.
  • Hugelius, Karin, Julia Becker, and Annsofie Adolfsson. 2020. “Five Challenges When Managing Mass Casualty or Disaster Situations: A Review Study.” International Journal of Environmental Research and Public Health 17 (9): 3068.
  • Jarvis, Paul Richard Edwin. 2016. “Improving Emergency Department Patient Flow.” Clinical and Experimental Emergency Medicine 3 (2): 63–68. https://doi.org/10.15441/ceem.16.127.
  • Johnson, Mark, Nicola Burgess, and Simon Sethi. 2020. “Temporal Pacing of Outcomes for Improving Patient Flow: Design Science Research in a National Health Service Hospital.” Journal of Operations Management 66 (1–2): 35–53. https://doi.org/10.1002/joom.1077. Kelen, Gabor D, Richard Wolfe, Gail D’Onofrio, Angela M Mills, Deborah Diercks, Susan A Stern,
  • Michael C Wadman, and Peter E Sokolove. 2021. “Emergency Department Crowding: The Canary in the Health Care System.” NEJM Catalyst Innovations in Care Delivery 2 (5).
  • Khan, Yasmin, Tracey O’Sullivan, Adalsteinn Brown, Shannon Tracey, Jennifer Gibson, Mélissa Généreux, Bonnie Henry, and Brian Schwartz. 2018. “Public Health Emergency Preparedness: A Framework to Promote Resilience.” BMC Public Health 18: 1–16. Konrad, Renata, Kristine DeSotto, Allison Grocela, Patrick McAuley, Justin Wang, Jill Lyons, and
  • Michael Bruin. 2013. “Modeling the Impact of Changing Patient Flow Processes in an Emergency Department: Insights from a Computer Simulation Study.” Operations Research for Health Care 2 (4): 66–74. https://doi.org/https://doi.org/10.1016/j.orhc.2013.04.001.
  • Lovett, Paris B., Megan L. Illg, and Brian E. Sweeney. 2016. “A Successful Model for a Comprehensive Patient Flow Management Center at an Academic Health System.” American Journal of Medical Quality 31 (3): 246–55. https://doi.org/10.1177/1062860614564618.
  • Mahmud, Ehtisham, Harold L Dauerman, Frederick G P Welt, John C Messenger, Sunil V Rao, Cindy Grines, Amal Mattu, Ajay J Kirtane, Rajiv Jauhar, and Perwaiz Meraj. 2020. “Management of Acute Myocardial Infarction during the COVID-19 Pandemic: A Position Statement from the Society for Cardiovascular Angiography and Interventions (SCAI), the American College of Cardiology (ACC), and the American College of Emergency Physicia.” Journal of the American College of Cardiology 76 (11): 1375–84.
  • McIntyre, Daniel, and Clara K Chow. 2020. “Waiting Time as an Indicator for Health Services under Strain: A Narrative Review.” INQUIRY: The Journal of Health Care Organization, Provision, and Financing 57: 0046958020910305.
  • Mercer, Mary P., Malini K. Singh, and Hemal K. Kanzaria. 2019. “Reducing Emergency Department Length of Stay.” JAMA 321 (14): 1402. https://doi.org/10.1001/jama.2018.21812.
  • Molnar, Alex D. 2023. “Using Simulation in Healthcare Emergency Transport to Improve Efficiency and Safety.” Ohio University. Murphy, Peter, Paresh Wankhade, and Katarzyna Lakoma. 2020. “The Strategic and Operational Landscape of Emergency Services in the UK.” International Journal of Emergency Services 9 (1): 69–88. Nugus, Peter, Anna Holdgate, Margaret Fry, Roberto Forero, Sally McCarthy, and Jeffrey
  • Braithwaite. 2011. “Work Pressure and Patient Flow Management in the Emergency Department: Findings From an Ethnographic Study.” Academic Emergency Medicine 18 (10): 1045–52. https://doi.org/10.1111/j.1553-2712.2011.01171.x.
  • Ouda, Eman, Andrei Sleptchenko, and Mecit Can Emre Simsekler. 2023. “Comprehensive Review and Future Research Agenda on Discrete-Event Simulation and Agent-Based Simulation of Emergency Departments.” Simulation Modelling Practice and Theory, 102823.
  • Pak, Anton, Brenda Gannon, and Andrew Staib. 2021. “Predicting Waiting Time to Treatment for Emergency Department Patients.” International Journal of Medical Informatics 145 (January): 104303. https://doi.org/10.1016/j.ijmedinf.2020.104303.
  • Rau, Chi-Lun, Pei-Fang Jennifer Tsai, Sheau-Farn Max Liang, Jhih-Cian Tan, Hong-Cheng Syu, Yue-Ling Jheng, Ting-Syuan Ciou, and Fu-Shan Jaw. 2013. “Using Discrete-Event Simulation in Strategic Capacity Planning for an Outpatient Physical Therapy Service.” Health Care Management Science 16 (4): 352–65. https://doi.org/10.1007/s10729-013-9234 2.
  • Saghafian, Soroush, Garrett Austin, and Stephen J Traub. 2015. “Operations Research/Management Contributions to Emergency Department Patient Flow Optimization: Review and Research Prospects.” IIE Transactions on Healthcare Systems Engineering 5 (2): 101–23.
  • Scanlon, Joseph, Ira Helsloot, and Jelle Groenendaal. 2014. “Putting It All Together: Integrating Ordinary People into Emergency Response.” International Journal of Mass Emergencies & Disasters 32 (1): 43–63.
  • Ung, Carolina Oi Lam. 2020. “Community Pharmacist in Public Health Emergencies: Quick to Action against the Coronavirus 2019-NCoV Outbreak.” Research in Social and Administrative Pharmacy 16 (4): 583–86.
  • Vázquez-Serrano, Jesús Isaac, Leopoldo Eduardo Cárdenas-Barrón, Julio C Vicencio-Ortiz, Timothy Matis, Carlos Martín Gaitán-Mercado, and Rodrigo E Peimbert-García. 2024. “Hybrid Optimization and Discrete-Event Simulation Model to Reduce Waiting Times in a Primary Health Center.” Expert Systems with Applications 238: 121920.
There are 36 citations in total.

Details

Primary Language English
Subjects Health Management
Journal Section Makaleler
Authors

Abdulkadir Atalan

Publication Date March 27, 2024
Submission Date February 1, 2024
Acceptance Date March 10, 2024
Published in Issue Year 2024 Volume: 9 Issue: 1

Cite

APA Atalan, A. (2024). Changing the Patient Flow Process for the Green Area of Emergency Department: A Discrete-Event Simulation Approach. International Journal of Health Management and Tourism, 9(1), 45-63.