Simulation of the patient flow at Vrinnevi hospital emergency department

Abstract: The Vrinnevi hospital in Norrköping faces a series of changes in conjunction with “Vision 2020”, the emergency ward is no exception. One of the goals that has been set up is to have 80 % of the arriving patients leave the ER within four hours, while having received the proper care. This study maps out the flow of patients through the ER, from arrival to discharge, as well as the process in between. The study also identifies the areas where bottlenecks in the patient flow are likely to appear and describes countermeasures to remedy such situations. In order to achieve this, a simulation model has been created. Facts used in the study are mainly based on previous studies, interviews with employees at the emergency ward, as well as some assumptions based on a theoretical background. Visits to the ER in question have been made, to gain a better understanding of the system that the simulation will illustrate. The study does not contain any deeper economic analysis. The focus is placed on examining whether the proposed changes to the system will affect the patient flow by measuring number of discharged patients within four hours, number of patients who receive a medical assessment within 30 minutes and the number of patients who get to meet a doctor within an hour. Five different scenarios, changing the work process at the ER, based on previous studies attempting to reduce patient throughput, have been created. The scenarios have been analyzed to form an understanding of how they may affect the different efficiency measurements of the emergency ward. The scenarios that have been simulated are: implementation of doctor-assisted triage, implementation on a “Clinical Initiative Nurse” in the waiting room, a reduction of administrative workload for the employees and adding resources to the emergency ward during specific hours of the day. Lastly, a combination scenario containing experiments with three of the most efficient measures has been created in order to achieve a discharge rate of 80 % within four hours. In conclusion, it is evident that all the scenarios have a positive effect on the efficiency measurements and that they all can be implemented so long as there is a positive attitude towards change and, in some cases, economic support.