257
Chapter 31
Simulation in Healthcare
Tarun Mohan Lal and Thomas Roh
Introduction
As healthcare costs continue to rise and providers move toward optimizing the care delivery pro-
cesses with the Institute for Healthcare Improvement (IHI)s triple aim of improving patient expe-
rience, improving health of populations, and reducing costs as the eventual goal, the ability to
assess trade-os among resource utilization, service, and operating costs is becoming more and
more important. Simulation, successfully applied in other industries, is an industrial engineer-
ing methodology that provides the ability to assess such trade-os and is now gaining traction
in healthcare. is chapter discusses the use of simulation modeling in studying and improving
health systems. e chapter will cover the basics of discrete event simulation model development,
and its common applications in healthcare.
Contents
Introduction .............................................................................................................................257
Denition of Simulation and Its Importance and Growth ........................................................258
Example: Major Applications in Healthcare .............................................................................258
Steps in a Simulation Study ......................................................................................................259
Example Project ...................................................................................................................... 260
Situation ............................................................................................................................. 260
Objective ............................................................................................................................ 260
Analysis .............................................................................................................................. 260
Results .................................................................................................................................261
Advantages and Disadvantages of Simulation .......................................................................... 262
Software Decision ................................................................................................................... 262
Future of Simulation in Healthcare ......................................................................................... 263
Bibliography ............................................................................................................................ 263
258Tarun Mohan Lal and Thomas Roh
Denition of Simulation and Its Importance and Growth
e term simulation refers to imitationorenactmentofa future event. Simulation in healthcare
sometimes refers to physical simulation in which education centers are set up for training care
providers to practice real patient care in an articial environment. In a medical context, the words
model and simulation can have several meanings and are beyond the scope of this chapter. e
focus of this chapter will be on an analytical computer simulation technique known as discrete
event simulation that is often used by management engineers or operations research experts to
evaluate, optimize, and improve care delivery processes. In this technique, historical data are used
to imitate or simulate the operations of various kinds of healthcare systems to provide an approxi-
mation of future outcomes. As an example of simulation, consider a hospital that is contemplating
a decision to add beds in the intensive care unit to reduce the time that a patient must wait to
be moved into an inpatient unit. It is not certain that adding more beds would truly reduce the
congestion in the system, and even if it does, the number of additional beds required to make this
a nancially viable option is unknown.
A healthcare system is often referred to as a system of systems due to multiple components that
are both operationally and managerially dependent. ere is also a high level of variability, mak-
ing them stochastic in nature. When the relationships that compose the system are simple, it is
possible to use simple mathematical methods to obtain exact information on questions of interest
and provide an analytical solution. However, for complex systems such as most healthcare pro-
cesses, with multiple moving parts, deterministic methodologies do not give the desired accuracy.
e use of simulation is crucial in order to estimate the desired characteristics.
Simulation is used when the proposed change cannot be implemented without a signicant
change in practice that might be too disruptive or too expensive. It can be used to justify improve-
ments or to nd the bottlenecks in a system without a huge investment. Going back to the exam-
ple of additional beds in the ICU, for example, it would certainly not be cost eective to add beds
and then remove them later if it does not work. However, discrete event simulation could throw
light on the question by simulating the operations of the hospital as they are currently and as they
would be if the number of beds were increased.
Example: Major Applications in Healthcare
Application areas for simulation in healthcare are numerous and diverse. e following is a list
of some of the problems in healthcare for which simulation has been found to be a useful and
powerful tool.
Hospital operations
Bed occupancy and utilization
Stang analysis
Operating room scheduling
Patient ow analysis
Emergency department
Patient triage and its impact on resource needs
Number of beds needed
Patient ow from emergency department to hospital inpatient units
Stang analysis

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