This document discusses discrete event simulation in healthcare. It provides an overview of simulation, including common application areas like manufacturing, transportation, and healthcare. Simulation allows testing of proposed solutions and scenarios in a model without real-world costs or risks. The key steps of simulation include creating workflow charts, collecting data, building a simulation environment, running scenarios, and analyzing results. Common simulation software packages are discussed. An example case study compares performance measures between scenarios with and without an additional medical test to assess impacts. The conclusion emphasizes how simulation can help improve patient flow, decrease wait times, and increase efficiency in healthcare.

1. Abdulkadir Atalan, Ph.D.
Department of Industrial Engineering
2018
Discrete Event Simulation in Healthcare

2. Simulation
“Simulation refers to
a broad collection of
methods and
applications to mimic
the behavior of real
systems, usually on a
computer with
appropriate
software”.
(Source: Kelton, 2004)

3. Simulation Application Areas
• Has been used
– Manufacturing facility
– Bank operation
– Airport operations (passengers, security, planes, crews,
baggage)
– Transportation/logistics/distribution operation
– Computer network
– Business process (insurance office)
– Fast-food restaurant
– Supermarket
– Communications
• Is becoming widespread in healthcare delivery as well.

4. Why Simulation?
q Less Expense: If we apply proposed solution scenarios
directly clinic which might be expensive such as schedule
modifications and additional bed, rooms or staff. There might
be a chaos.
q What if Scenarios: Simulation has ability to test what-if
scenarios in a model of your facility.
q Time Consuming: Simulation can simulate weeks worth of
operations in minutes, allowing you to quickly insight into
how proposed solutions cases can effect overall productivity
over long periods.
q Provided With Statistical Analyzes: Give more detail
statistical and mathematical information which gives us high
level of confidence.

5. Simulation Steps
• Create Workflow Charts
• Collect Necessary Historical
Data
• Form Simulation environment
based on real physical area.
• Run Whole System into
Software one to one.
• Create possible Case scenarios.
• Analyzes results.

6. Simulation Software
Most common used:
• SIMUL8: Software for discrete event or process based simulation.
• Arena: Discrete & Continuous systems, 2D,3D Animation, Based
on SIMAN
• Flexsim: Discrete-event, Object-oriented simulator; developed in
C++ using Open GL, Animation: 2D, 3D, Virtual reality
• ProMod: Manufacturing Systems, Simulation & Animation (2D &
3D)
• ExtendSim: Block-diagram approach, Versions for mixed and for
continuous only, C programming language
• AnyLogic: discrete event, using
• Etc….
“ Many do have trial versions”

7. Case Study
We compare performance measures between the
two cases to asses the impact of the additional
activity.
Figure: Flexsim Software Screenshot

8. Using Distribution for Activities
Patient Arrival Patient Check-in Nurse Triage Time Patient Urine Test
Physician
Co n su ltatio n
Check O u t
Patient Departure
Patient Arrival Patient Check-in Nurse Triage Time Physician
Co n su ltatio n
Check O u t Patient Departure
Process Time Assigned
Arriving Patient Exponential (0.0, 10.0, 0)
Check-in Uniform (3, 5, 0)
Triage Triangular (3, 15.0, 5, 0)
Treatment by Physician Uniform (20, 30, 0)
Check-out Uniform (3, 5, 0)

9. Simulation Output
Number of patients in waiting room vs. time
Resources Utilization Rate

10. Case Scenarios
Flexsim: Design of Simulation Scenarios
Arena: Design of Simulation Scenarios

11. Optimization
“Simulation is a powerful “what-if” technology that allows you to
model and experiment with several alternative scenarios so that
you can select the one that best meets your objectives.”
(Source: Arena OptQuest)

12. Comparison of Cases
Without
Extra Test
With
Extra Test
Ave Patient Waiting Time (min)
Ave Patient Waiting Time in Clinic (min)
Ave Exam Room Utilization (percentage)
Note that adding a 3 minutes test can increase patient waiting
and total time 15 to 20 minutes

13. Conclusion
Using Simulation Tool to show
the target of Six Sigma:
• Improving patient flow process
• Decreasing patient waiting time
• Increasing patient satisfaction
• Reducing process cost
• Increasing resources utilization

14. THANK YOU!