A structured literature review of simulation modelling applied to Emergency Departments: Current patterns and emerging trends

Salmon, Andrew; Rachuba, Sebastian; Briscoe, Simon; Pitt, Martin

doi:10.1016/j.orhc.2018.01.001

Cited by 63 publications

(54 citation statements)

References 30 publications

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“…Firstly, many of them target the ED (Eatock et al, ; Mohiuddin et al, ; Paul et al, ). Reviewers have suggested that the reason for this focus is the growing demand for emergency care, hence its public importance, ED's system within a system functionality, and the common and readily mappable characteristics of the patient journey (Salmon et al, ). Secondly, the studies overwhelmingly use DES or ABM, which is consistent with a study focus on improving operational level decisions.…”

Section: Research Recognition For Sd In Health Carementioning

confidence: 99%

“…With minimal effort, SD is a simulation tool that can use existing databases and build on existing research to produce holistic models that provide policy makers and decisions makers with credible insights and answers (Michael & Bryan, 2013). Despite the growing number of applications of SD in the health care sector, and its toolbox of both qualitative and quantitative tools, the use of SD remains largely underutilized (Organisation for Economic Co-operation and Development, 2017;Paul, Reddy, & DeFlitch, 2010;Salmon, Rachuba, Briscoe, & Pitt, 2018).…”

Section: Goals Of This Investigationmentioning

confidence: 99%

“…Mohiuddin et al (2017) recommended further research to establish to what extent outputs are being translated into policy. Salmon et al (2018) presented a structured review of simulation modelling applied to EDs in any context, identifying 254 relevant publications dating back to 2000 of which 82% used DES. Seven percent (18) used SD as the main method of simulation and five percent of papers combined SD with DES (Salmon et al, 2018).…”

Section: Research Recognition For Sd In Health Carementioning

confidence: 99%

“…Within the ED, the scope of conventional modelling studies has had a day‐to‐day operational focus typically involving a single closed cohort, wherein transitions usually occur at specified time intervals, as opposed to a higher tactical or longer term strategic objective. For this reason, queuing methodologies and DES focusing on patient behaviours have been the most commonly employed modelling methods (Paul et al, ; Salmon et al, ). The focus is not on process but rather tasks, people, and structures (Petersen, ).…”

Section: Scope Of Traditional and Dominant Approachesmentioning

confidence: 99%

“…In a review of publications between 2008 and 2015 targeting DES and agent‐based models, all but one of the studies, where improving ED performance was the objective, used DES. A 2017 systematic review of current patterns and emerging trends in simulation modelling in EDs found DES to be the sole or dominant method used in 209 papers (Salmon et al, ).…”

Section: Scope Of Traditional and Dominant Approachesmentioning

confidence: 99%

See 4 more Smart Citations

Models of evaluation under ceteris imparibus: System dynamics and the example of emergency care

2019

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Traditional and current approaches to modelling the impacts of health care interventions have focused on detail complexity and been ceteris paribus dependent and thereby ignored the wider system impacts. In this study, we have demonstrated that system dynamics (SD) offers theoretical and practical advantages over conventional methodologies and the qualitative assessment tools that have informed the business of emergency care. We translate the key findings of qualitative research, existing literature reviews and studies of the use of simulation and economic evaluation models into a value proposition for using SD tools. We conclude that there is growing evidence of a strong value proposition for the use of SD tools to investigate interventions targeting improved emergency care access. SD models can incorporate dynamic and organizational complexity and fill a gap beyond the microscope of the conventional methodologies informing health care. This potential to strengthen health care systems warrants further investigation.

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Section: Research Recognition For Sd In Health Carementioning

confidence: 99%

Section: Goals Of This Investigationmentioning

confidence: 99%

Section: Research Recognition For Sd In Health Carementioning

confidence: 99%

Section: Scope Of Traditional and Dominant Approachesmentioning

confidence: 99%

Section: Scope Of Traditional and Dominant Approachesmentioning

confidence: 99%

See 3 more Smart Citations

Models of evaluation under ceteris imparibus: System dynamics and the example of emergency care

2019

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

Daldoul

Nouaouri²,

Bouchriha

et al. 2022

Health Planning & Management

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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.

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Can a system dynamics model of the emergency department show which levers reduce bottlenecks and delays to improve access to care?

2020

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The purpose of this paper is to demonstrate through practical application how a system dynamics (SD) patient flow model of an emergency department (ED) can show which levers effectively reduce backlogs to improve access to care. Overcrowded EDs are struggling to meet demand and access targets. In 2016 and 2017, in the UK and Australia, respectively, 15% and 28% of arrivals waited longer than the targeted 4-hr treatment time. Historically, simulation models that have informed access to emergency care have ignored the wider systems impacts. There is a growing awareness of the value of systems analysis tools for informing interventions and policy. In this study, we constructed a pilot system dynamics patient flow model, where the scope was the ambulatory and ambulance patient arrivals, the ED processes for acute and fast-track pathways, pathology and radiology services, the ED short-stay unit, and the Medical Assessment Planning Inpatient Unit. Patients queued to access constrained ED resources (doctors and beds) and diagnostic services (pathology and X-ray). The model was tested on actual data from five separate historical periods spanning 3 years. The resultant daily pattern of peaks and troughs in patient flow and system delays accurately replicated patterns in actual patient flows, resource use, and the location of delays. "What if" scenario analysis (b) simulated how access would have looked in the sample weeks with different intervention strategies, (b) simulated system limits on the basis of current resources, (c) accurately identified levers that historically have been most effective at minimizing ambulance ramping, and (d) identified when additional staffing would fail to improve flow.

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A structured literature review of simulation modelling applied to Emergency Departments: Current patterns and emerging trends

Cited by 63 publications

References 30 publications

Models of evaluation under ceteris imparibus: System dynamics and the example of emergency care

Models of evaluation under ceteris imparibus: System dynamics and the example of emergency care

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

Can a system dynamics model of the emergency department show which levers reduce bottlenecks and delays to improve access to care?

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