Your SlideShare is downloading. ×
Ensuring the feasibility of a $31 million OR expansion project: Capacity planning, system design, and patient flow with SIMUL8 simulation software
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Ensuring the feasibility of a $31 million OR expansion project: Capacity planning, system design, and patient flow with SIMUL8 simulation software

478

Published on

Ensuring the feasibility of a $31 million OR expansion project: Capacity planning, system design, and patient flow …

Ensuring the feasibility of a $31 million OR expansion project: Capacity planning, system design, and patient flow

Presenter: Todd Roberts, Memorial Health System

The second workshop in our series will look at a recent project at Memorial Health System (MHS) in Illinois.

Todd Roberts, System Director of Operations Improvement at MHS will discuss and demonstrate the use of discrete simulation modeling to analyze floor design and throughput for a new Rapid Clinical Examination provider model for a 70,000 annual visit, Level I trauma center emergency department at a 507 bed, tertiary, urban, academic medical center and flow for all aspects of architectural design proposal for $31 million dollar operating room expansion project, including pre-op admission, transport to OR, OR time, and post-anesthesia care units (PACU) for admitted and outpatient surgery.

Through the use of discrete simulation modeling, Memorial has reduced length to stay for non-admitted patients in the emergency department by 27%, reduced percentage of patients leaving by without treatment by 50%, and released admit hold time by 37% while improving patient satisfaction from the 57th to 99th percentile (Press Ganey).

In addition, Memorial has used simulation to determine the appropriate facilities layout for its new OR expansion project, determining that optimizing the flow of traffic will lead to a reduction of 30 minutes per case in wasted movement and waiting.

Published in: Technology, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
478
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888
  • 2. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 • • •
  • 3. Memorial Health System Discrete Event Simulation Todd S. Roberts, MBA, CLSSMBB System Director, Operations Improvement Memorial Health System May 15, 2013
  • 4. Systems thinking is the ability to see things as a whole (or holistically), including the many different types of relationships between the diverse elements of a complex system Necessary component of “learning organizations” Takes cause-and-effect thinking to a higher level and encourages the user to see not just the linear causal connections but also the web of causal interconnections that come into play in real systems “The Fifth Discipline”
  • 5. “Adjusting the system or process inputs to produce the best possible average response with minimum variability” System Optimization
  • 6. The sensitive dependence on initial conditions, where a small change at one place can result in large differences to a later state. Butterfly Effect
  • 7. Three types of failures in complex systems: – Procedural • Failure to adhere to/execute a defined process • Single, obvious mistakes • Special-cause variation • Plan, Do, Check, Act or corrective action – Engineered • People, process, materials • Common-cause variation • Defined processes • Lean Six Sigma projects – System • Complex interactions between processes and risk factors • Difficult to understand and pinpoint cause and effect relationships • Discrete event simulation Failure in Complex Systems
  • 8. Simulated floor design and throughput for new Rapid Clinical Examination provider model for a 70,000 annual visit, Level I trauma center emergency department at a 507 bed, tertiary, urban, academic medical center Simulation was constructed using floor layout schematic and provider resource models based upon historic hourly ED arrival (Poisson) and service distribution rates (exponential) for high, mid, and low acuity patients as well as admitted vs. discharged dispensation ED Flow Redesign Project
  • 9. Goals of the simulation model were as follows: – Determine the most efficient model for routing patients through the system (high acuity patients to main ED, low acuity patients to rapid clinical examination) – Determine the number of provider resources necessary for staffing based upon patient distribution – Determine primary macro factors affecting length of stay for all patients – Identify process constraints and bottlenecks – Identify factors contributing to increased patient wait time and patients leaving without treatment (LWOT) ED Simulation Goals
  • 10. Determined the appropriate routing model for patients to the main ED and the Rapid Clinical Examination process The provider mix was adjusted to accommodate peak volumes throughout the day in an effort to minimize wait times and LWOTS A number of Lean Six Sigma projects were chartered based upon the findings of the Simulation model, including time from imaging complete to discharge, lab turnaround time, and CT utilization and turnaround time Simulation Results
  • 11. EMERGENCY DEPARTMENT RAPID CLINICAL EXAMINATION MODEL POST-IMPROVEMENT DATA
  • 12. UCL 285.2 CL 208.9 LCL 132.5 104 154 204 254 304 354 404 01/01/2013 02/01/2013 03/01/2013 04/01/2013 05/01/2013 06/01/2013 07/01/2013 08/01/2013 09/01/2013 10/01/2013 11/01/2013 12/01/2013 13/01/2013 14/01/2013 15/01/2013 16/01/2013 17/01/2013 18/01/2013 19/01/2013 20/01/2013 22/01/2013 23/01/2013 24/01/2013 25/01/2013 26/01/2013 27/01/2013 28/01/2013 29/01/2013 30/01/2013 31/01/2013 01/02/2013 02/02/2013 03/02/2013 04/02/2013 05/02/2013 06/02/2013 07/02/2013 08/02/2013 09/02/2013 10/02/2013 11/02/2013 12/02/2013 13/02/2013 14/02/2013 15/02/2013 16/02/2013 17/02/2013 OverallLOS Date Overall Length of Stay 16% Improvement
  • 13. UCL 231.8 CL 154.7 LCL 77.6 49 59 69 79 89 99 109 119 129 139 149 159 169 179 189 199 209 219 229 239 249 259 269 279 289 01/10/2012 06/10/2012 11/10/2012 16/10/2012 21/10/2012 26/10/2012 31/10/2012 05/11/2012 10/11/2012 15/11/2012 20/11/2012 25/11/2012 30/11/2012 05/12/2012 10/12/2012 15/12/2012 20/12/2012 25/12/2012 30/12/2012 04/01/2013 09/01/2013 14/01/2013 19/01/2013 23/01/2013 28/01/2013 02/02/2013 07/02/2013 12/02/2013 17/02/2013 22/02/2013 27/02/2013 04/03/2013 09/03/2013 14/03/2013 19/03/2013 24/03/2013 29/03/2013 03/04/2013 08/04/2013 12/04/2013 17/04/2013 22/04/2013 27/04/2013 RCELOS Date Rapid Clinical Examination Length of Stay 26% Overall Improvement
  • 14. UCL 356.2 CL 259.6 LCL 163.0 130 155 180 205 230 255 280 305 330 355 380 405 430 455 480 505 530 01/01/2013 04/01/2013 07/01/2013 10/01/2013 13/01/2013 16/01/2013 19/01/2013 22/01/2013 25/01/2013 28/01/2013 31/01/2013 03/02/2013 06/02/2013 09/02/2013 12/02/2013 15/02/2013 18/02/2013 21/02/2013 24/02/2013 27/02/2013 02/03/2013 05/03/2013 08/03/2013 11/03/2013 14/03/2013 17/03/2013 20/03/2013 23/03/2013 26/03/2013 29/03/2013 01/04/2013 04/04/2013 07/04/2013 09/04/2013 12/04/2013 15/04/2013 18/04/2013 21/04/2013 24/04/2013 27/04/2013 30/04/2013 MainEDLOS Date Main ED Length of Stay 16% Improvement
  • 15. UCL 4.83% CL 1.27% 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00% 8.00% 9.00% 10.00% 01/10/2012 06/10/2012 11/10/2012 16/10/2012 21/10/2012 26/10/2012 31/10/2012 05/11/2012 10/11/2012 15/11/2012 20/11/2012 25/11/2012 30/11/2012 05/12/2012 10/12/2012 15/12/2012 20/12/2012 25/12/2012 30/12/2012 04/01/2013 09/01/2013 14/01/2013 19/01/2013 23/01/2013 28/01/2013 02/02/2013 07/02/2013 12/02/2013 17/02/2013 22/02/2013 27/02/2013 04/03/2013 09/03/2013 14/03/2013 19/03/2013 24/03/2013 29/03/2013 03/04/2013 08/04/2013 12/04/2013 17/04/2013 22/04/2013 27/04/2013 LWOTas%ofTotalVolume Date Left Without Treatment (LWOT) as % of Total Volume 53% Improvement
  • 16. ED Admitted Patient Average Length of Stay (minutes) 2nd consecutive month below 200 minutes & 1st month below 100 minutes
  • 17. UCL 211.908 CL 125.017 LCL 38.125 4.70 104.70 204.70 304.70 404.70 504.70 604.70 01/01/2013 02/01/2013 03/01/2013 04/01/2013 05/01/2013 06/01/2013 07/01/2013 08/01/2013 09/01/2013 10/01/2013 11/01/2013 12/01/2013 13/01/2013 14/01/2013 15/01/2013 16/01/2013 17/01/2013 18/01/2013 19/01/2013 20/01/2013 21/01/2013 22/01/2013 23/01/2013 24/01/2013 25/01/2013 26/01/2013 27/01/2013 28/01/2013 29/01/2013 30/01/2013 31/01/2013 01/02/2013 02/02/2013 03/02/2013 04/02/2013 05/02/2013 06/02/2013 07/02/2013 08/02/2013 09/02/2013 10/02/2013 11/02/2013 12/02/2013 13/02/2013 14/02/2013 15/02/2013 16/02/2013 17/02/2013 AdmitRequesttoCheckoutAverage Date ED Admit Request to Checkout Average 50% Improvement
  • 18. Emergency Department Patient Satisfaction over 80th%ile for 3nd consecutive month & 2nd consecutive month at 98th%ile or above . 2nd quarter FY 2013 99th%ile .
  • 19. – May 2012 – RCE Launch – July 1, 2012 – RCE Fully implemented 7 days/week – August 17, 2012 – RCE Red Flag criteria change (based on Simulation) – January 21, 2013 – 4th lane of RCE added (Based on Simulation) – April 9, 2013 – ED facilities remodeled to support process flow Key Process Changes
  • 20. Simulate flow for all aspects of architectural design proposal for $31 million dollar operating room expansion project, including pre-op admission, transport to OR, OR time, and post- anesthesia care units (PACU) for admitted and outpatient surgery Test assumptions for capacity based on an expansion of 5 operating rooms (and pre- op/PACU beds) and increased volumes of 15% over the next 5 years OR Renovation Design Simulation
  • 21. 2 Elevators 3 Elevators Operating Room Opportunity Cost = $54/minute
  • 22. Identified process bottlenecks and determined that with a surge of patients transported to the OR for first and second-case starts, that two elevators from the pre-op holding area to the ORs is not adequate for flow, and will lead to staff, physician, and patient dissatisfaction while increasing overall variation by 30 minutes per case throughout the day. Decision was made to add a third elevator to the design to satisfy flow demand The discovery of downstream increase in variation could not have been achieved and recognized using static waiting line models. Simulation Results
  • 23. Lean Six Sigma projects have been chartered to streamline scheduling processes and OR room turnover processes to further reduce variation and increase capacity Studies conducted for projected increased volume year over year have allowed the building of adequate facilities for the next 20 years Next Steps
  • 24. Requires deep process understanding (avoid tampering) Creates a shared visual understanding of the process for all parties Allows for observational analysis and modification without physical intervention in a complex environment (offline trial and error) Supports improved decision-making through management by fact Discrete Event Simulation Benefits
  • 25. Contact: roberts.todd@mhsil.com (217) 757-7782
  • 26. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 • •

×