University of Twente Student Theses


Organizing acute care : logistic optimization of an integrated emergency post using discrete event simulation

Borgman, N.J. (2012) Organizing acute care : logistic optimization of an integrated emergency post using discrete event simulation.

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Abstract:In April 2010, the emergency department (ED) of ZGT Almelo and the after hours general practitioners post (CHPA) merged into a single integrated emergency post. To benefit most from this collaboration, a research project started in April 2011. This project is called “Optimal logistics and patient preferences in acute care: the general practitioners post and emergency post in one integrated emergency post”. The goal of this project is to find an optimal design of an integrated emergency post where the right patient arrives at the right care provider without unnecessary delays and with an optimal allocation of means, while accounting for patient preferences (Doggen, Hans, Snel, Velde, & Verheij, 2010). As part of this project, a computer simulation model is designed (Visser, 2011). This thesis is part of the research project, and details the use of the simulation model to evaluate possible organizational interventions. The goal of this study is to assess possible organizational interventions for the integrated emergency post and to optimize over these interventions using simulation. To reach this goal we first further modify, verify and validate the simulation model, such that it correctly reflects the conceptual model, as well reality. Following this, possible organizational interventions are evaluated using experimental designs in an iterative approach, such that the effects of interventions, a well as their interaction on each other are analyzed. From the intervention analysis, we conclude that several changes have a positive effect on the patient length of stay. These are the treatment of ED patients in GP post rooms, the direct ordering of pre-diagnostic tests for patients that likely need them, direct bed admission requests, using a single triage system, and letting physician assistants (PA) work at both ED and GP post. Furthermore, the pooling of resources such as sharing of rooms and simultaneous employment of staff allows for a reduced length of stay, while sharing costs. The greatest reduction on length of stay is seen when staff is added that treats either low urgency GP post, surgical specialty ED patients, or both, reflected by the desired ZGT roster, or addition of a PA during the weekends, or IEP starting hours. Overall, we conclude that the interventions show a significant improvement over the current situation, and that combining them results in the greatest length of stay reductions, for both ED as well as GP post patients, by increasing flexibility through the pooling of resources, while maintaining similar workloads.
Item Type:Essay (Master)
Ziekenhuisgroep Twente, the Netherlands
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Business Administration MSc (60644)
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