Combining simulation and goal programming for healthcare planning in a medical assessment unit

Integrated decision making in healthcare : an operations research and management science perspective

“…This leads to patient dissatisfaction, medical errors, and decreased staff satisfaction [393]. A typical cause of congestion in the ED is the delay in admitting emergency patients to an inpatient bed due to congested medical care units and ICUs [16,91,106,375,376,491]. Congestion may also be caused by insufficient available resources in the surgical care services (e.g., operating time capacity) and ambulatory care serivces (e.g., diagnostic equipment).…”

“…Staff in emergency care services is composed of different skill and responsibility levels, for example doctors, emergency nurses and support staff [60,181,220,282,311,375,376,393,532]. Required staffing dimensions, and thereby staff costs, may be reduced by passing on non-critical patients from doctors to lower-qualified, less-costly staff, releasing doctors to work on the critical cases [60].…”

“…These are observation wards for a temporary stay, possibly before admission to the general wards [16,106,375,376], also called Acute Admission Unit (AAU). Capacity is generally given in the number of beds.…”

“…For example, staff members may be 'on call' while working elsewhere or being off-duty, and they are called upon when additional staff is required in the ED to cope with unexpected demand peaks [376]. Methods: computer simulation [16,40,60,91,165,181,186,267,311,315,375,412,429,526,532], heuristics [38], mathematical programming [38,39,165,375,376,412], queueing theory [106,220,446,468], literature review [62,282,393].…”

“…When emergency demand for ambulances or in the emergency care facility is significantly higher than predicted or when staff is lower than expected (e.g., absent due to illness), additional staff may be required. Especially when senior doctors, who are required for key decisions such as discharge and particular treatments of a patient, are unexpectedly unavailable, it is recommended to call in an additional senior doctor [375]. Methods: computer simulation [532], mathematical programming [375].…”