Overcrowding in the Emergency Department (ED) is one of the most important issues in healthcare systems. This situation leads to an increase in the length of stay, a decrease in the quality of care, and the burnout of nursing staff. Two major causes of this overcrowding are unjustified Emergency Department visits and a lack of downstream beds.
Business process modeling and process mining are relevant tools able to model patient pathways in hospitals, and simulation allows a dynamic study.
This research proposes a generic simulation model as one of the ED overcrowding solutions to analyze patient pathways from the ED to hospital discharge.
The project is based on the Southern Brittany Hospital (SBH) case study. SBH is a merger of two hospitals. This fusion would lead to a major reorganization of the SBH. They were searching for solutions to avoid overcrowding by improving patient pathways from admission in the ED to discharge.
The research team focused on a stroke case study because this pathology has several interesting characteristics: it is the first cause of acquired handicap, the third cause of death, and with more than 1 case every 4 minutes, stroke is a major public health challenge in France.
About the Model
In the simulation model, the research team included all ischemic strokes for the year 2018 in the South Brittany Hospital (Quimperl´e Hospital and Lorient Hospital). This set includes a total of 534 cases with 170 variants of pathways.
The team used AnyLogic 8.5.1 to develop the simulation model. The data set represented 6 months of hospitalizations with 1 month of Warm-Up.
Then the researchers proposed several designs of experiments to test medical unit capacity variations considering real data and practitioners’ expertise.