Using simulation and Data Envelopment Analysis in optimal healthcare efficiency allocations

As in many other parts of the world, overcrowding in Taiwan's hospital Emergency Departments (ED) is an increasingly scrutinized area. EDs in Taiwan hospitals must implement efficient systems that minimize costs while also providing satisfactory levels of care. The primary goal of this investigation is to develop and deploy a mixed method incorporating Discrete Event Simulation (DES) and Data Envelopment Analysis (DEA) to evaluate potential bottlenecks, maximize throughput flows, and identify solutions in reducing patient time in the ED while also increasing patient satisfaction. Hospital administrators can use the model data as a realistic reproduction to evaluate different scenarios and make modifications which best fit hospital operations. This paper incorporates various types of ED resources as inputs including: number of physicians, number of nurses, and number of beds. We assessed the impact of changing levels of these inputs on ED operation efficiency, with optimal efficiency resource allocations as the goal.

[1]  Zbigniew J. Pasek,et al.  Simulation-based verification of lean improvement for emergency room process , 2008, 2008 Winter Simulation Conference.

[2]  P. Sprivulis,et al.  Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia , 2005, Emergency Medicine Journal.

[3]  Sheldon Howard Jacobson,et al.  Application of discrete-event simulation in health care clinics: A survey , 1999, J. Oper. Res. Soc..

[4]  Da Ruan,et al.  Integrating data envelopment analysis and analytic hierarchy for the facility layout design in manufacturing systems , 2006, Inf. Sci..

[5]  George W. Wilson,et al.  Competition, Profit Incentives, and Technical Efficiency in the Provision of Nuclear Medicine Services , 1982 .

[6]  T. R. Nunamaker Measuring routine nursing service efficiency: a comparison of cost per patient day and data envelopment analysis models. , 1983, Health services research.

[7]  Thomas R. Sexton,et al.  The methodology of data envelopment analysis , 1986 .

[8]  A. U.S.,et al.  Measuring the efficiency of decision making units , 2003 .

[9]  Fatah Chetouane,et al.  Modeling and Improving Emergency Department Systems using Discrete Event Simulation , 2007, Simul..

[10]  Chuan Zhou,et al.  Forecasting emergency department crowding: a prospective, real-time evaluation. , 2009, Journal of the American Medical Informatics Association : JAMIA.

[11]  Gilles Reinhardt,et al.  Analysis of factors influencing length of stay in the emergency department. , 2003, CJEM.

[12]  D. Aronsky,et al.  Systematic review of emergency department crowding: causes, effects, and solutions. , 2008, Annals of emergency medicine.

[13]  Alkin Yurtkuran,et al.  Simulation based decision-making for hospital pharmacy management , 2008, 2008 Winter Simulation Conference.

[14]  Alexander Komashie,et al.  Modeling emergency departments using discrete event simulation techniques , 2005, Proceedings of the Winter Simulation Conference, 2005..

[15]  Jeffrey P Harrison,et al.  An efficiency analysis of Veterans Health Administration hospitals. , 2005, Military medicine.

[16]  R. Vogel,et al.  Emergency department use by nursing home residents. , 1998, Annals of emergency medicine.

[17]  S. M. Wang,et al.  ED overcrowding in Taiwan: facts and strategies. , 1999, The American journal of emergency medicine.

[18]  Emmanuel Thanassoulis,et al.  A Comparison of Regression Analysis and Data Envelopment Analysis as Alternative Methods for Performance Assessments , 1993 .

[19]  C. Drury Barnes,et al.  Advanced uses for Micro Saint simulation software , 1998, 1998 Winter Simulation Conference. Proceedings (Cat. No.98CH36274).

[20]  S. Grosskopf,et al.  Measuring hospital performance. A non-parametric approach. , 1987, Journal of health economics.

[21]  Nunamaker Tr,et al.  Measuring routine nursing service efficiency: a comparison of cost per patient day and data envelopment analysis models. , 1983 .

[22]  Aditi Saxena,et al.  The Emergency Department , 2010 .

[23]  Richard A. Wysk,et al.  Multi-pass expert control system - a control/scheduling structure for flexible manufacturing cells , 1988 .

[24]  S Grosskopf,et al.  Evaluating hospital performance with case-mix-adjusted outputs. , 1993, Medical care.

[25]  R. Derlet,et al.  Overcrowding in emergency departments: increased demand and decreased capacity. , 2002, Annals of emergency medicine.

[26]  Siamak Tavakoli,et al.  Flexible Data Input Layer Architecture (FDILA) for Quick-Response Decision Making Tools in Volatile Manufacturing Systems , 2008, 2008 IEEE International Conference on Communications.

[27]  Todd G Nick,et al.  Estimating the degree of emergency department overcrowding in academic medical centers: results of the National ED Overcrowding Study (NEDOCS). , 2004, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[28]  K. Ronald Laughery,et al.  Advanced uses for Micro Saint simulation software , 1996, Winter Simulation Conference.

[29]  A. Charnes,et al.  Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis , 1984 .

[30]  J. Twanmoh,et al.  When overcrowding paralyzes an emergency department. , 2006, Managed care.

[31]  J. Kirigia,et al.  Cost Effectiveness and Resource Allocation Open Access Technical Efficiency of Public District Hospitals and Health Centres in Ghana: a Pilot Study , 2005 .