Discrete event simulation for problem solving in the context of an emergency department

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Letícia Ali Figueiredo Ferreira
Igor Leão dos Santos
Ana Carla de Souza Gomes dos Santos
Augusto da Cunha Reis
صندلی اداری


Emergency departments (ED) are responsible for the immediate care and stabilization of patients in critical health conditions. Several factors have caused overcrowding in the emergency care system, but the variability of patient arrival and the triage process requires special attention. The criticality of these components and their configuration directly impact the waiting times, length of stay and quality of service, being the subject of several studies. So, this paper aims to understand by means of Discrete Event Simulation how ED works with the variation of patient arrival and how this variation highlights the bottlenecks of the triage process. Varying the patient arriving interval between 0.1 and 7.6 in a 4-hour scenario,  the system saturation point was established in β = 1.1. Besides, with the variation in the number of triages points, a considerable decrease in the total length of stay spent and the waiting times were noticed, mainly when there was two triage points operating simultaneously.


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Author Biographies

Letícia Ali Figueiredo Ferreira, CEFET/RJ

She is a master's student in Industrial and Systems Engineering at Federal Center for Technological Education Celso Suckow da Fonseca (CEFET/RJ) in the Healthcare 4.0 line of research and a collaborating researcher at Federal Institute of Education, Science, and Technology of Rio de Janeiro, Campus Nilopolis as member of the Research Group of Industrial Production Management in the lean operations line of research. She graduated in Industrial Engineering at the Federal University of Jequitinhonha and Mucuri Valleys (2018) and in Science and Technology (2016) at the same university. Her undergraduate process was partly held at Morgan State University (Baltimore, MD, USA) as she took courses related to Industrial and Systems Engineering after participating in the Science Without Borders Program (2014-2015).

Igor Leão dos Santos, CEFET/RJ

He is an Industrial Engineer (2011) by the Polytechnic School of the Federal University of Rio de Janeiro (UFRJ). Specialist (2013) in Production Management Technologies by the Educational Society of Santa Catarina (SOCIESC). Master (2013) and Ph.D. (2017) in Computer Science by the Post-Graduation Program in Computer Science (PPGI) of UFRJ. Works as Adjunct Professor at the graduation course in Production Engineering from the Federal Center of Technological Education Celso Suckow da Fonseca (CEFET-RJ), Campus Maracanã. Research interests: Wireless Sensor Networks (WSN); Internet of Things (IoT); Cloud of Sensors (CoS); Edge / Fog Computing; Production Management; Industry 4.0.


Ana Carla de Souza Gomes dos Santos, IFRJ - Nilopolis CEFET/RJ

She is a Ph.D. student in Industrial and Systems Engineering at Federal Center for Technological Education Celso Suckow da Fonseca (CEFET/RJ) in the lean healthcare line of research and a professor at the Federal Institute of Education, Science, and Technology of Rio de Janeiro, campus Nilopolis. She is master’s in industrial engineering by UENF (2016), Project Management Specialist by FGV (2015), and a bachelor’s in industrial engineering by Nossa Senhora Auxiliadora Educational Center (2012). Her general field of research and experience is in Industrial Engineering, focusing on Production and Quality Management.

Augusto da Cunha Reis, CEFET/RJ

He is a Ph.D. in Industrial Engineering from PUC-RJ. Master’s in industrial engineering and graduated in Business Administration from PUC-RJ. Professor of the Industrial Engineering Department at the Federal Center for Technological Education Celso Suckow da Fonseca (CEFET/RJ) with experience and focus on the following subjects: supply chain management, product variable personnel management, health logistics and reverse logistics. As a teacher, he also worked at SENAI, SENAC, UCAM, and UNIFESO. Participation in master’s and Doctorate Stands (UFF, UFRJ, PUC-Rio, and Unirio).


AHALT, V.; ARGON, N. T.; ZIYA, S.; STRICKLER, J.; MEHROTRA, A. (2018) Comparison of emergency department crowding scores: a discrete-event simulation approach, Health Care Management Science, v. 21, n. 1, p. 144–155. doi: 10.1007/s10729-016-9385-z.

ARAZ, O. M.; OLSON, D.; RAMIREZ-NAFARRATE, A. (2019) Predictive analytics for hospital admissions from the emergency department using triage information, International Journal of Production Economics, v. 208, p. 199–207. doi: 10.1016/j.ijpe.2018.11.024.

ASPLIN, B. R.; MAGID, D. J.; RHODES, K. V.; SOLBERG, L. I.; LURIE, N.; CAMARGO JUNIOR, C. A. (2003) A conceptual model of emergency department crowding, Annals of Emergency Medicine, v. 42, n. 2, p. 173–180. doi: 10.1067/mem.2003.302.

BARBOSA FILHO, F. H. (2017) A crise econômica de 2014/2017, Estudos Avançados, v. 31, n. 89, p. 51–60. doi: 10.1590/s0103-40142017.31890006.

CHENG, I.; TAYLOR, D.; SCHULL, M. J.; ZWARENSTEIN, M.; KISS, A.; CASTREN, M.; BROMMELS, M.; YEOH, M.; KERR, F. (2019) Comparison of emergency department time performance between a Canadian and an Australian academic tertiary hospital, Emergency Medicine Australasia, v. 31, n. 4, p. 605–611. doi: 10.1111/1742-6723.13247.

DI SOMMA, S.; PALADINO, L.; VAUGHAN, L.; LALLE, I.; MAGRINI, L.; MAGNANTI, M. (2015) Overcrowding in emergency department: an international issue, Internal and Emergency Medicine, v. 10, n. 2, p. 171–175. doi: 10.1007/s11739-014-1154-8.

EMINE, S.; BOULEUX, G.; HAOUBA, H.; MARCON, E. (2018) Emergency Department Overcrowding Detection by a Multifractal Analysis, in 10th IFAC Symposium on Biological and Medical Systems (IFACBMS 2018). Sao Paulo, Brazil. Available at: https://hal.archives-ouvertes.fr/hal-01876444 (Accessed: 2 September 2019), doi: 10.1016/j.ifacol.2018.11.659.

GÖTTEMS, L. B. D.; BITTENCOURT, R. J.; SANTANA, M. I. R. L.; PIRES, M. R. G. M.; CAMPO, J. (2016) Contratualização regionalizada de serviços públicos de saúde no Distrito Federal: relato de experiência, Revista Eletrônica Gestão e Saúde, n. 1, p. 282–308.

ISMAIL, K.; THORWARTH, M.; ARISHA, A. (2014) Integrated decision support systems for improving emergency department performance in irish hospitals, International Journal of Operational Research, v. 19, n. 1, p. 40–59. doi: 10.1504/IJOR.2014.057843.

KANE, M.; CHUI, K.; RIMICCI, J.; CALLAGY, P.; HEREFORD, J.; SHEN, S.; NORRIS, R.; PICKHAM, D. (2015) Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction, JONA: The Journal of Nursing Administration, v. 45, n. 9, p. 429–434. doi: 10.1097/NNA.0000000000000228.

LEE, I.-H.; CHEN, C. T.; LEE, Y. T.; HSU, Y. S.; LU, C. L.; HUANG, H. H.; HSU, T. F.; HOW, C. K.; YEN, D. H.; YANG, U. C. (2017) A new strategy for emergency department crowding: High-turnover utility bed intervention, Journal of the Chinese Medical Association, v. 80, n. 5, p. 297–302. doi: 10.1016/j.jcma.2016.11.002.

LIN, C.-H.; KAO, C.-Y.; HUANG, C.-Y. (2015) Managing emergency department overcrowding via ambulance diversion: A discrete event simulation model, Journal of the Formosan Medical Association, v. 114, n. 1, p. 64–71. doi: 10.1016/j.jfma.2012.09.007.

VAN DER LINDEN, M. C.; MEESTER, B. E. A. M.; VAN DER LINDEN, N. (2016) Emergency department crowding affects triage processes, International Emergency Nursing, v. 29, p. 27–31. doi: 10.1016/j.ienj.2016.02.003.

LIU, Y.-C.; HO, C. H. (2018) A comparison of car following behaviors: Effectiveness of applying statistical quality control charts to design in-vehicle forward collision warning systems, Transportation Research Part F: Traffic Psychology and Behaviour, v. 53, p. 143–154. doi: 10.1016/j.trf.2017.09.010.

MARCELINO, D. M.; LOPES, P. H.; CAPOCCI, N. R. (2015) Simulação: um estudo de caso de um hospital municipal no estado de São Paulo, São Paulo, p. 12.

MELTON, J. D.; BLIND, F.; HALL, A. B.; LECKIE, M.; NOVOTNY, A. (2016) Impact of a Hospitalwide Quality Improvement Initiative on Emergency Department Throughput and Crowding Measures, The Joint Commission Journal on Quality and Patient Safety, v. 42, n. 12, p. 533–542. doi: 10.1016/S1553-7250(16)30104-0.

MOHIUDDIN, S.; BUSBY, J.; SAVOVIC, J.; RICHARDS, A.; NORTHSTONE, K.; HOLLINGWORTH, W.; DONOVAN, J. L.; VASILAKIS, C. (2017) Patient flow within UK emergency departments: a systematic review of the use of computer simulation modelling methods, BMJ Open, v. 7, n. 5, p. e015007. doi: 10.1136/bmjopen-2016-015007.

OLUGBOJI, O.; CAMORLINGA, S. G.; FARIA, R. L.; KAUSHAL, A. (2018) Understanding the Emergency Department Ecosystem Using Agent-Based Modeling: A Study of the Seven Oaks General Hospital Emergency Department, in Sturmberg, J. P. (ed.) Putting Systems and Complexity Sciences Into Practice. Cham: Springer International Publishing, p. 199–214. doi: 10.1007/978-3-319-73636-5_15.

SALDIVA, P. H. N.; VERAS, M. (2018) Gastos públicos com saúde: breve histórico, situação atual e perspectivas futuras, Estudos Avançados, v. 32, n. 92, p. 47–61. doi: 10.5935/0103-4014.20180005.

SANCHES, C. B.; SANTOS, L. C.; SILVA, M. M. (2016) Modelagem e simulação do fluxo de pacientes em uma clínica médica, Revista GEINTEC - Gestão, Inovação e Tecnologias, v. 6, n. 2, p. 3079–3094. doi: 10.7198/geintec.v6i2.834.

VON THIELE SCHWARZ, U., HASSON, H. AND MUNTLIN ATHLIN, Å. (2016) ‘Efficiency in the emergency department – A complex relationship between throughput rates and staff perceptions’, International Emergency Nursing, 29, pp. 15–20. doi: 10.1016/j.ienj.2016.07.003.

TORTORELLA, G. L.; FOGLIATTO, F. S.; ANZANELLO, M.; MARODIN, G. A.; GARCIA, M.; ESTEVES, R. R. (2017) Making the value flow: application of value stream mapping in a Brazilian public healthcare organisation, Total Quality Management & Business Excellence, v. 28, n. 13–14, p. 1544–1558. doi: 10.1080/14783363.2016.1150778.

VANBRABANT, L.; BRAEKERS, K.; RAMAEKERS, K.; NIEUWENHUYSE, I. A. (2019) Simulation of emergency department operations: A comprehensive review of KPIs and operational improvements, Computers and Industrial Engineering, v. 131, p. 356–381. doi: 10.1016/j.cie.2019.03.025.

VASHI, A. A.; SHEIKHI, F. H.; NASHTON, L. A.; ELLMAN, J.; RAJAGOPAL, P.; ASCH, S. M. (2019) Applying Lean Principles to Reduce Wait Times in a VA Emergency Department, Military Medicine, v. 184, n. 1–2, p. e169–e178. doi: 10.1093/milmed/usy165.

WANG, Z.; XIONG, X.; WUANG, S.; YAN, J.; SPRINGER, M.; DELLINGER, R. P. (2018) Causes of Emergency Department Overcrowding and Blockage of Access to Critical Services in Beijing: A 2-Year Study, The Journal of Emergency Medicine, v. 54, n. 5, p. 665–673. doi: 10.1016/j.jemermed.2018.02.009.

WHITE, B. A.; CHANG, Y.; GRABOWSKI, B. G.; BROWN, D. F. M. (2014) Using lean-based systems engineering to increase capacity in the emergency department, Western Journal of Emergency Medicine, v. 15, n. 7, p. 770–776. doi: 10.5811/westjem.2014.8.21272.

WILER, J. L.; WELCH, S.; PINES, J.; SCHUUR, J.; JOURILES, N.; STONE-GRIFFITH, S. (2015) Emergency department performance measures updates: Proceedings of the 2014 emergency department benchmarking alliance consensus summit, Academic Emergency Medicine, v. 22, n. 5, p. 542–553. doi: 10.1111/acem.12654.

YARMOHAMMADIAN, M. H.; REZAEI, F.; HAGHSHENAS, A.; TAVAKOLI, N. (2017) Overcrowding in emergency departments: A review of strategies to decrease future challenges, Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences, v. 22. doi: 10.4103/1735-1995.200277.

YOUSEFI, M.; FERREIRA, R. P. M. (2017) An agent-based simulation combined with group decision-making technique for improving the performance of an emergency department, Brazilian Journal of Medical and Biological Research, v. 50, n. 5. doi: 10.1590/1414-431X20175955.

ZEINALI, F.; MAHOOTCHI, M.; SEPEHRI, M. M. (2015) Resource planning in the emergency departments: A simulation-based metamodeling approach, Simulation Modelling Practice and Theory, v. 53, p. 123–138. doi: 10.1016/j.simpat.2015.02.002.

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