Improving emergency department resource planning: a multiple case study

Simulation-based optimisation approach to improve emergency department resource planning: A case study of Tunisian hospital

BACKGROUND

The emergency department (ED) is a gateway to hospitals and is in the centre of hospital management efforts. It is often saturated by a continuous flow of patients, which causes excessive patient waiting time.

AIMS

This study integrates simulations with optimisation to design planning decision support for an ED. We considered all the processes of the ED, from triage to bed assignment. This study's main objective was to determine the optimal number of doctors, nurses, and beds required to schedule patients with different acuity levels to minimise both the total patient waiting time and the patient average length of stay and balance the resource utilisation rates. The problem is also characterised by multiple uncertainties, such as the patient arrival rate and service times in each stage of the process.

METHOD

We first propose a stochastic mixed-integer programing model that is solved using the sample average approximation approach. The resulting resource sizing is then evaluated using a discrete-event simulation model by comparing different patient scheduling rules.

RESULTS

Numerical experiments highlight the performance of the proposed approach using data from a Tunisian ED hospital.

An Overview of Hospital Capacity Planning and Optimisation

Health care is uncertain, dynamic, and fast growing. With digital technologies set to revolutionise the industry, hospital capacity optimisation and planning have never been more relevant. The purposes of this article are threefold. The first is to identify the current state of the art, to summarise/analyse the key achievements, and to identify gaps in the body of research. The second is to synthesise and evaluate that literature to create a holistic framework for understanding hospital capacity planning and optimisation, in terms of physical elements, process, and governance. Third, avenues for future research are sought to inform researchers and practitioners where they should best concentrate their efforts. In conclusion, we find that prior research has typically focussed on individual parts, but the hospital is one body that is made up of many interdependent parts. It is also evident that past attempts considering entire hospitals fail to incorporate all the detail that is necessary to provide solutions that can be implemented in the real world, across strategic, tactical and operational planning horizons. A holistic approach is needed that includes ancillary services, equipment medicines, utilities, instrument trays, supply chain and inventory considerations.