Improvement of the service level of an Emergency Department using Discrete event simulation

Abstract: Emergency departments in Sweden are usually struggling with long waiting times, delays and bottlenecks in the system. The National Board of Health and Welfare and the County Council of Västra Götaland have established to decrease the average time a patient stays in an emergency department as important priority as well as the waiting time to be seen by a nurse and by a physician. Healthcare systems are usually characterized by its complexity because of the variability and stochastic nature of the different processes involved in the flow of patients, staff and resources. In order to increase the use of the existing resources and to reduce the waiting times of patients, a system improvement methodology involving discrete-event simulation and process analysis has been used. In this project a computer-based simulation tool was applied at the emergency department of the hospital Kärnsjukhuset in Skövde, which belongs to Skaraborgs Sjukhus and is one of the largest emergency departments in the region of Västra Götaland. A three-dimensional model was created to help visualize and understand the problems, as well as to identify improvements by the different stakeholders involved. Continually, the simulation model was modified to test possible improved scenarios with the aim to increase the service level of the system.  The design, implementation and analysis of these scenarios have provided decision makers of the emergency department with the necessary information to implement or reject the ideas of the different improved scenarios. Some of these scenarios had a significant impact with small changes so they were implemented in the real system; some others had non-significant impact in the results so they were not implemented. The main result of this project has been to identify which system changes will lead to a reduction of the different waiting times of patients. In addition, the simulation and experiments of future solutions show a more efficient use of the existing resources. This design of a better configuration of the system gives Kärnsjukhuset the possibility to increase the service level of the system and to meet some of the requirements established by the County Council. This project shows that the use of simulation tools provides enormous benefits for healthcare system analysis and improvement; new ideas and scenarios can be designed without disturbing the normal activities of the hospital, saving considerable time, money and resources.