Patient flow simulation modelling - an approach conducive to multi-disciplinary collaboration towards hospital capacity management

Emergency hospitals continue to face increasing demand and operate at high occupancy levels resulting in more frequent crowding and prolonged waiting. These issues are not expected to abate, but may become more frequent as hospital activity is predicted to increase. Patient wait and crowding issues are outcomes that can be attributed to multiple causes. It will be important for hospital and health care managers to adopt new tools that will enable them to investigate the complex issue of patient flow through the emergency department and hospital in order to improve patient flow and minimise delays. Simulation has been employed in various industries to achieve process improvement. Although simulation has been employed to investigate patient flow issues in health care its use as a routine management tool is yet to occur. The lack of up take of simulation may be attributed to a variety of factors including confusion about which methodology should be employed and the capacity to accurately model the complex health environment. There are a variety of approaches to simulation including systems dynamic, discrete event and agent based modelling. Until recently off the shelf software packages enabled the modelling of systems using a single method. AnyLogic (anylogic.com) has been identified as a software package that enables a multi-method approach to be adopted and has been sufficiently proven in its use to warrant investigation as a tool to assist in the creation of simulation models of patient flow. The increased capacity of computers and the reduction in costs of both hardware and software are also no longer a barrier to the implementation of simulation as a means of investigating health care management problems. The possession of modelling skills alone is insufficient to enable the development of a meaningful simulation patient flow model. Multi-disciplinary collaboration between a range of professionals is also required to enable the capture of the necessary information required to describe the hospital processes, analyse the data, create the and validate the model. The aim of this project is to create an accurate simulation model of patient flow that accurately describes the progression of patients through the emergency department of a large teaching hospital into general medicine wards and then discharge. This paper describes the development of a concept for simulation modeling of the service and describes an initial model created by a multi-disciplinary team that will be used to investigate scenarios and strategies for improving patient flow through the hospital and reducing waiting times in the emergency department. The visual and quantitative outcome of this study will enable health care professionals and managers to understand the impact of their decisions on the hospital's operation efficiency as well as patient experiences.