Title
Simulation-based models of emergency departments:: Operational, tactical, and strategic staffing
Abstract
The Emergency Department (ED) of a modern hospital is a highly complex system that gives rise to numerous managerial challenges. It spans the full spectrum of operational, clinical, and financial perspectives, over varying horizons: operational—a few hours or days ahead; tactical—weeks or a few months ahead; and strategic, which involves planning on monthly and yearly scales. Simulation offers a natural framework within which to address these challenges, as realistic ED models are typically intractable analytically. We apply a general and flexible ED simulator to address several significant problems that arose in a large Israeli hospital. The article focuses mainly, but not exclusively, on workforce staffing problems over these time horizons. First, we demonstrate that our simulation model can support real-time control, which enables short-term prediction and operational planning (physician and nurse staffing) for several hours or days ahead. To this end, we present a novel simulation-based technique that implements the concept of offered-load and discover that it performs better than a common alternative. Then we evaluate ED staff scheduling that adjusts for midterm changes (tactical horizon, several weeks or months ahead). Finally, we analyze the design and staffing problems that arose from physical relocation of the ED (strategic yearly horizon). Application of the simulation-based approach led to the implementation of our design and staffing recommendations.
Year
DOI
Venue
2011
10.1145/2000494.2000497
ACM Trans. Model. Comput. Simul.
Keywords
Field
DocType
staffing problem,modern hospital,flexible ed simulator,nurse staffing,simulation-based model,large israeli hospital,operational planning,staffing recommendation,emergency department,workforce staffing problem,strategic staffing,ed staff scheduling,realistic ed model,real time control,offered load,queuing theory,health care,spectrum,complex system,queues,simulation model,strategic planning
Operational planning,Health care,Relocation,Staffing,Workforce,Scheduling (computing),Emergency department,Computer science,Operations research,Strategic planning
Journal
Volume
Issue
ISSN
21
4
1049-3301
Citations 
PageRank 
References 
11
0.62
18
Authors
14
Name
Order
Citations
PageRank
Sergey Zeltyn117415.09
Yariv N. Marmor2235.71
Avishai Mandelbaum3106185.79
Boaz Carmeli4416.70
Ohad Greenshpan519513.43
Yossi Mesika6212.96
Sergev Wasserkrug7110.62
Pnina Vortman8474.83
Avraham Shtub913516.44
Tirza Lauterman10342.63
Dagan Schwartz11161.34
Kobi Moskovitch12110.62
Sara Tzafrir13110.62
Fuad Basis14161.34