Computer simulation of A&E department
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Computer simulation of A&E department Towards shorter waiting in an accident and emergency department Xiao-Ming Huang, Chris Taylor and Ian Stewart As a result of the National Health Service (NHS)
reforms, the publication of the Patient's Charter and Performance League Tables, providers are under persistent pressure to improve their efficiency. This
article describes a recent simulation study of an Accident and Emergency (A&E) department in a large NHS Trust. A data collection survey is described which was essential for identifying patient flows and activity times in the A&E department. We
then discuss in more detail how to model patient arrivals which proved to be the most difficult part of
the simulation. Some light is also shed on the
An A&E department is a good example of a queuing system in the health service, in which patients have to wait for various activities, such as seeing a doctor,
having an X-ray, etc. However, because of the
complexity of the A&E system, queuing theory can not offer much help. We therefore decided to use
computer simulation techniques. The simulation package we used is WITNESS, a product of AT&T Istel. This article reports some of the efforts we have made in order to develop a valid model to answer the above questions.
attempt we made to develop a valid and credible
Data collection
model. Finally, the preliminary findings are presented.
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To develop a simulation model, we first need to understand how the department works, in other words, we need to know:
The Accident & Emergency department of Plymouth
how patients are classified and what priority rules are applied;
Hospitals NHS Trust has undergone a dramatic change in recent years. The A&E department has
seen an increase in workload of about 55% over the
last 2 years partly because of the closure of the city's second A&E department at the Royal Naval Hospital. Although the number of staff has increased, patient times and visit times still remain
what are the possible procedures followed by each type of patient; C)
what is the probability that a given proce-
short of the Local Patient's Charter standards set by
dure is followed;
ance is shown below:
how long it takes to perform a given activity;
the District Health Authority. The current performabout 72% of patients can be seen within an hour (compared to 90% in local standards)
what scarce resources (doctor, nurse, receptionist, porter, etc) each activity requires.
about 73% of patients can have their treatments completed within 2 hours (compared to 80% in local standards)
All patients coming to the A&E department have an initial assessment carried out by a specially trained nurse (a senior nurse), who reports on the nature
In order to improve performance, two immediate questions need to be answered:
how to schedule and utilise the currently available staff in order to reduce patient waiting times and visit times;
how many extra staff are required, if necessary, to enable the specified service stand-
ards to be achieved, that is, the standards re
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