Emergency Department Problems: A Call for Hybrid Simulation

 Abstract— Emergency department (ED) is a unit in hospital that provides treatment for acutely ill and injured patients 24 hours daily. As a system, ED reveals detailed and dynamic complexity of its interaction between inter-departmental units and intra-departmental elements. Discrete event simulation (DES) has been recognized with its ability to comprehend micro level problems with detailed complexity. From the macro level perspective, system dynamics (SD) has advantages over DES based on its holistic view capability that is able to capture the dynamic relationships between elements in a system. Both modeling approaches have strengths and weaknesses and therefore integrating both will provide a more realistic view of complex systems. This paper is based on an on- going study that uses computer simulation, a branch of Operation Research techniques in modeling an actual ED of a general hospital in Penang, Malaysia. We describe the potential benefits of integrating SD and DES in exhibiting both detailed and dynamic complexity of the ED. We propose a hybrid simulation framework with intent to better understand system's behavior and how patient flow in the ED is influenced by capacity availability.

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