research-article

Simulation-based models of emergency departments:: Operational, tactical, and strategic staffing

Authors:

Yariv N. Marmor,

Avishai Mandelbaum,

Ohad Greenshpan,

Sergev Wasserkrug,

Tirza Lauterman,

Dagan Schwartz,

Kobi Moskovitch,

Fuad BasisAuthors Info & Claims

ACM Transactions on Modeling and Computer Simulation (TOMACS), Volume 21, Issue 4

Article No.: 24, Pages 1 - 25

https://doi.org/10.1145/2000494.2000497

Published: 02 September 2011 Publication History

Abstract

The Emergency Department (ED) of a modern hospital is a highly complex system that gives rise to numerous managerial challenges. It spans the full spectrum of operational, clinical, and financial perspectives, over varying horizons: operational—a few hours or days ahead; tactical—weeks or a few months ahead; and strategic, which involves planning on monthly and yearly scales. Simulation offers a natural framework within which to address these challenges, as realistic ED models are typically intractable analytically. We apply a general and flexible ED simulator to address several significant problems that arose in a large Israeli hospital. The article focuses mainly, but not exclusively, on workforce staffing problems over these time horizons. First, we demonstrate that our simulation model can support real-time control, which enables short-term prediction and operational planning (physician and nurse staffing) for several hours or days ahead. To this end, we present a novel simulation-based technique that implements the concept of offered-load and discover that it performs better than a common alternative. Then we evaluate ED staff scheduling that adjusts for midterm changes (tactical horizon, several weeks or months ahead). Finally, we analyze the design and staffing problems that arose from physical relocation of the ED (strategic yearly horizon). Application of the simulation-based approach led to the implementation of our design and staffing recommendations.

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cover image ACM Transactions on Modeling and Computer Simulation

ACM Transactions on Modeling and Computer Simulation Volume 21, Issue 4

August 2011

115 pages

ISSN:1049-3301

EISSN:1558-1195

DOI:10.1145/2000494

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Copyright © 2011 ACM.

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Publication History

Published: 02 September 2011

Accepted: 01 June 2010

Revised: 01 October 2009

Received: 01 June 2009

Published in TOMACS Volume 21, Issue 4

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