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Integrated Simulation Model for Patient Flow Between Operating Rooms and Progressive

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Integrated Simulation Model for Patient Flow Between Operating Rooms and Progressive Integrated Simulation Model for Patient Flow Between Operating Rooms and Progressive Care Units Using Custom Objects A thesis presented to the faculty of the Russ College of Engineering and Technology of Ohio University In partial fulfillment of the requirements for the degree Master of Science Ryan L. Miller December 2020 © 2020 Ryan L. Miller. All Rights Reserved. 2 This thesis titled Integrated Simulation Model for Patient Flow Between Operating Rooms and Progressive Care Units Using Custom Objects by RYAN L. MILLER has been approved for the Department of Industrial and Systems Engineering and the Russ College of Engineering and Technology by Dušan Šormaz Professor of Industrial and Systems Engineering Mei Wei Dean, Russ College of Engineering and Technology 3 ABSTRACT MILLER, RYAN L., M.S., December 2020, Industrial and Systems Engineering Integrated Simulation Model for Patient Flow Between Operating Rooms and Progressive Care Units Director of Thesis: Dušan Šormaz Process improvements in hospitals usually focus on a single department (eg. emergency department, operating theater, specialty clinic, etc). However, actions taken in one department inevitably affect the performance of other departments. Therefore, higher efficiency improvements can be obtained by considering the patient care process as one synergetic activity involving several departments and various sets of resources. In this research we propose an integrated approach for modeling the patient lifecycle for multiple departments. First we describe a patient flow from his/her entry into the hospital through a progressive care unit until the patient has fully recovered. We use process mapping methods to address value added activities and other necessary activities in the patient lifecycle. Then, a simulation model is developed in Simio using customized objects created in previous works. Those customized objects carry their own logic and behavior. For example, the Bed object includes logic for a patient recovering while using several hospital resources (nurses, therapist) in his/her hospital stay. Those objects were used to build several configurations of an integrated model with multiple departments. Data about patient arrival patterns, their health acuity, and procedure needs were obtained from a real hospital in order to test our approach. The procedures duration data 4 (which were different for different levels of patient acuity and for different surgical and other procedures) were used to obtain service distribution using statistical analysis methods. Modular simulation objects and data distributions from real hospitals allowed us to build an integrated simulation model with several configurations of the process flow. Simulation experiments were performed on these models and performance recorded. The recommendation for implementations in the hospitals is also reported. 5 DEDICATION This thesis is dedicated to my wife Laura DiNardo Miller. Her hard working attitude inspired me to see this through, after life had taken me away from studies for a long time. Without her every day encouragement I would have never completed this work. 6 ACKNOWLEDGMENTS I would like to give a big thanks to my advisor, Dr. Dusan Sormaz. He has never wavered in his support for both my studies and life in general. There have been many challenges we have had to overcome to complete this work, including a global pandemic. Without his belief in me and his guidance, I don’t know that I would have ever been able to reach this goal. My wife and family have always been of great support to me, and I’m so very grateful for them. I also wish to give a great thanks to my good friend and academic peer Arkopaul Sarkar who has quietly pushed and encouraged me to get this work done. Finally, a big thanks to the entire ISE department at Ohio University. The faculty and staff have always been accommodating and encouraging. It is evident that they truly care about the students. 7 TABLE OF CONTENTS Page Abstract ............................................................................................................................... 3 Dedication ........................................................................................................................... 5 Acknowledgments............................................................................................................... 6 List of Tables ...................................................................................................................... 9 List of Figures ................................................................................................................... 10 Chapter 1: Introduction ..................................................................................................... 13 Advantages .................................................................................................................. 15 Disadvantages ............................................................................................................. 15 Chapter 2: Literature Review ............................................................................................ 19 2.1 Discrete Event Simulation in Healthcare Systems................................................ 19 2.2 Simulation Studies on Patient Flow ...................................................................... 22 2.2.1 Simulation of Multiple Associated Healthcare Units .................................. 25 2.2.2 Generic Modeling ........................................................................................ 26 2.2.3 Object Oriented Modeling ........................................................................... 28 Chapter 3: Thesis Objective and Overview ...................................................................... 32 3.1 PCU Overview ...................................................................................................... 32 3.2 Surgical Unit Overview ........................................................................................ 38 3.3 Principles of Integration ........................................................................................ 41 Chapter 4: Methodology ................................................................................................... 44 4.1 Testing Bed Object ............................................................................................... 44 4.2 Enhancing Bed Unit Model .................................................................................. 48 4.2.1 Rounding Conflicts ...................................................................................... 52 4.2.2 Adjusting for Multiple Beds ........................................................................ 72 4.2.3 Changing Acuity and Routing Final Destination ......................................... 76 4.3 Two Units Integrated to One Model ..................................................................... 84 4.4 Statistic Collection & Experiments ....................................................................... 93 4.4.1 Statistic Collection ....................................................................................... 93 4.4.2 Experiments ................................................................................................. 98 Chapter 5: Conclusion and Future Work ........................................................................ 103 5.1 Summary ............................................................................................................. 103 8 5.2 Conclusion .......................................................................................................... 104 5.3 Future Work ........................................................................................................ 105 References ....................................................................................................................... 106 9 LIST OF TABLES Table 1: Patient Origin Breakdown .................................................................................. 34 Table 2: Patient Origin broken down by acuity level ....................................................... 34 Table 3: PCU patient arrival distribution .......................................................................... 35 Table 4: PCU Activities .................................................................................................... 37 Table 5: Patient Destinations ............................................................................................ 38 Table 6: DailyAppointments Data Table ........................................................................... 41 Table 7: Resource Rounding Times - Gantt Chart vs Simulation Comparison ................ 47 Table 8: HospitalData (transposed) .................................................................................. 50 Table 9: Patient Property and Variables in relation to Data Table ................................... 52 Table 10: Gantt Chart Data with one conflict ................................................................... 69 Table 11: HospitalData Data Input for one conflict ......................................................... 70 Table 12: Altered Gantt Chart Data .................................................................................. 70 Table 13: HospitalData data input for many conflicts ..................................................... 72 Table 14: Resource mix .................................................................................................
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