SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
1 800 547 6024 | +44 141 552 6888
SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
1 800 547 6024 | +44 141 552 6888
•
•
•
Memorial Health System
Discrete Event Simulation
Todd S. Roberts, MBA, CLSSMBB
System Director, Operations Improvement
Mem...
Systems thinking is the ability to see
things as a whole (or holistically),
including the many different types of
relation...
“Adjusting the system or process
inputs to produce the best possible
average response with minimum
variability”
System Opt...
The sensitive
dependence on initial
conditions, where a
small change at one
place can result in
large differences to a
lat...
Three types of failures in complex systems:
– Procedural
• Failure to adhere to/execute a defined process
• Single, obviou...
Simulated floor design and throughput for new
Rapid Clinical Examination provider model for a
70,000 annual visit, Level I...
Goals of the simulation model were as follows:
– Determine the most efficient model for routing
patients through the syste...
Determined the appropriate routing model for
patients to the main ED and the Rapid Clinical
Examination process
The provid...
EMERGENCY DEPARTMENT RAPID
CLINICAL EXAMINATION MODEL
POST-IMPROVEMENT DATA
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...
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
...
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/...
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/...
ED Admitted Patient Average Length of Stay (minutes) 2nd
consecutive month below 200 minutes & 1st month below 100
minutes
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
04/01/20...
Emergency Department Patient Satisfaction over 80th%ile for 3nd
consecutive month & 2nd consecutive month at 98th%ile or a...
– May 2012 – RCE Launch
– July 1, 2012 – RCE Fully implemented 7
days/week
– August 17, 2012 – RCE Red Flag criteria chang...
Simulate flow for all aspects of architectural
design proposal for $31 million dollar operating
room expansion project, in...
2 Elevators
3 Elevators
Operating Room Opportunity Cost
= $54/minute
Identified process bottlenecks and determined that
with a surge of patients transported to the OR for
first and second-cas...
Lean Six Sigma projects have been chartered to
streamline scheduling processes and OR room
turnover processes to further r...
Requires deep process understanding (avoid
tampering)
Creates a shared visual understanding of the
process for all parties...
Contact: roberts.todd@mhsil.com
(217) 757-7782
Ensuring the feasibility of a $31 million OR expansion project: Capacity planning, system design, and patient flow with SI...
Upcoming SlideShare
Loading in …5
×

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

2,670 views

Published on

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
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,670
On SlideShare
0
From Embeds
0
Number of Embeds
1,889
Actions
Shares
0
Downloads
12
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

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

  1. 1. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888
  2. 2. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 • • •
  3. 3. Memorial Health System Discrete Event Simulation Todd S. Roberts, MBA, CLSSMBB System Director, Operations Improvement Memorial Health System May 15, 2013
  4. 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. 5. “Adjusting the system or process inputs to produce the best possible average response with minimum variability” System Optimization
  6. 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. 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. 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. 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. 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. 11. EMERGENCY DEPARTMENT RAPID CLINICAL EXAMINATION MODEL POST-IMPROVEMENT DATA
  12. 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. 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. 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. 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. 16. ED Admitted Patient Average Length of Stay (minutes) 2nd consecutive month below 200 minutes & 1st month below 100 minutes
  17. 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. 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. 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. 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. 21. 2 Elevators 3 Elevators Operating Room Opportunity Cost = $54/minute
  22. 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. 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. 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. 25. Contact: roberts.todd@mhsil.com (217) 757-7782

×