Use of Simulation Modeling to Investigate the Urgicare Operation During Phase I Transition

Open Access
Author:
Gaudelli, Allen
Graduate Program:
Industrial Engineering
Degree:
Master of Science
Document Type:
Master Thesis
Date of Defense:
None
Committee Members:
  • Deborah Jean Medeiros, Thesis Advisor
Keywords:
  • simulation
  • health care
Abstract:
Crowding is when an Emergency Department (ED) is operating in a state in which it does not have sufficient resources to accommodate another patient. Operating in this condition can ultimately compromise a patient’s quality of care. Several best practices have been developed to lessen the occurrence of ED crowding. An example of one such practice is a fast track – a dedicated set of resources within an ED reserved for processing patients of the lowest severity. The ED of the Williamsport Regional Medical Center (WRMC) utilizes a fast track (referred to as Urgicare). Currently, the hospital is undergoing a renovation and expansion. As construction is completed, the ED will transition to the remodeled areas in phases. It is the interest of WRMC to avoid the use of the existing Urgicare treatment area due to the distance between the Main ED and the Urgicare treatment area during the transition. Therefore, WRMC is interested in reserving beds of the Main ED for treating Urgicare patients. In this thesis, simulation is used to model the bed allocation for ED patients at WRMC. The model is used to simulate a Baseline Scenario and three proposed operational scenarios for Urgicare. The results of the Baseline Scenario are used as a benchmark from which the success of each proposed scenario can be evaluated. The proposed scenarios vary in the number of beds reserved in the Main ED for providing treatment to Urgicare patients. The key performance measures used are Provider after Triage time and Departure after Triage time, because this ED did not experience large delays before triage. All of the proposed scenarios maintained or improved on the performance level of the Baseline Scenario. Reserving three beds in the Main ED for Urgicare patients and a fourth bed for a Super-Urgi treatment area provided the greatest improvement. Main ED and Urgicare patients experienced a percent improvement in Provider after Triage time of 21.4% and 16.5%; likewise, the percent improvement in Departure after Triage time was 4.2% and 9.3%, respectively.