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Real-Time Bed Allocation with
                 Dynamic Simulation
                                                 Hosni Adra
                                              CreateASoft, Inc.




www.createasoft.com   @Copyright 2012, CreateASoft, Inc. All Rights Reserved   1   7/25/2012
Simulation Applications in Healthcare


              Patient Flow and Wait Time analysis
              Provider analysis
              OR Simulation and methods to improve OR efficiency
              ED Simulation
              Basic bed allocation implementation
              Clinics/Outpatient scheduling analysis
              And many more

www.createasoft.com   @Copyright 2012, CreateASoft, Inc. All Rights Reserved   2   7/25/2012
Dynamic Simulation


              Dynamic simulation environment differs from standard
              environments…
                      Highly interactive with fast model building capabilities.
                      On-the-fly changes– Modify, Analyze, Optimize the model on
                      the fly without the need to stop and restart the simulation
                      Connectivity to external data systems during the simulation
                      run
                      Initial state loading based on current environment state.
                      Dynamic model updates based on current constraints and
                      flows.

www.createasoft.com          @Copyright 2012, CreateASoft, Inc. All Rights Reserved   3   7/25/2012
The need for Dynamic Simulation


              Reduced time for model building
              Enable simulation for everyone within the organization
              Improve model accuracy
              Better optimization methods
              Improved analysis capability

              Provide “life to the model” beyond the initial simulation
              effort.

www.createasoft.com    @Copyright 2012, CreateASoft, Inc. All Rights Reserved   4   7/25/2012
Why Bed Allocation?
             OR                                      ED                          Patient
          Scheduling                               Arrivals                    Admittance
                                                                       Outpatient
                        Transfers
                                                                       Scheduling

                         Bed Availability
          Patient Experience And Hospital Efficiency
www.createasoft.com   @Copyright 2012, CreateASoft, Inc. All Rights Reserved   5            7/25/2012
Looking in the wrong place?


              Is the ED the real problem? Are patients waiting due to bed
              availability?

              OR efficiency impact, patients waiting too long in PACU?

              Forecasting with Real Data ?

              2 examples often missed in the analysis process.

www.createasoft.com    @Copyright 2012, CreateASoft, Inc. All Rights Reserved   6   7/25/2012
Other impacts


              Revenue reduction.
              Increase in length of stay.
              Reduction in patient satisfaction.
              Efficiency reduction and increased utilization.
              Improper use of resources.
              Impact on staff and providers.

              And many more

www.createasoft.com   @Copyright 2012, CreateASoft, Inc. All Rights Reserved   7   7/25/2012
Solution must have...


              Valid model representing the current state of the
              operation.
              Data – actual patient information data
              (HIPPA Compliant)
              Historical performance and data points.
              Staffing/provider constraint impact
              Ability to accurately forecast.
              Live model that can react to changes with minimum
              interaction.

www.createasoft.com     @Copyright 2012, CreateASoft, Inc. All Rights Reserved   8   7/25/2012
Proposed Solution
                                       Historical
           EMR                           data                                     Other Tracking
                                                                                     systems




                                           Dynamic Simulation

                      Live System – Constant Updates and monitoring




                                            Bed Allocation Needs
   Capacity constraints                        and Schedules                               Staff allocation
  and expected flow data
www.createasoft.com      @Copyright 2012, CreateASoft, Inc. All Rights Reserved        9                      7/25/2012
Data Side
                                                                                Seasonality       Short term
               EMR                                Historical                       data             Data
                                                    Data
       Data Abstraction
            Layer                                                     Forecasting effect factors




                                                                                 Staffing, spee
                                                       Tracking                   d, efficiency    Other factors
           Dynamic                                       data
          Simulation
                                                                        Tracking data effect factors


www.createasoft.com    @Copyright 2012, CreateASoft, Inc. All Rights Reserved            10                7/25/2012
Dynamic Simulation

                             Models                                       Bed Allocation
                           (OR,ED,…)                                          Rules




                      Current State
                                                                                           Scheduler
                         Loader


                                                             Results
                                                              Data
                                                              Store

www.createasoft.com       @Copyright 2012, CreateASoft, Inc. All Rights Reserved           11          7/25/2012
Dynamic Simulation Detail


              2 Methods to implement the simulation models
                      Single model for Overall Hospital view.
                      Multiple models connected through dynamic interface.

              Multiple models method provides
                      Better model validation
                      Faster delivery (multiple modelers)
                      Ramped up implementation
                      Distributed computing
www.createasoft.com         @Copyright 2012, CreateASoft, Inc. All Rights Reserved   12   7/25/2012
Multiple Dynamic simulation models

                                               ED
                                              Model
                 OR
                Model
                                                                                    Bed Allocation
                                                                                     Rules Model


                                              Dynamic
                                             Simulation
                                             Scheduler
       Other Related                                                             Bed Re-Allocation Rules
          Models                                                                         Model


www.createasoft.com     @Copyright 2012, CreateASoft, Inc. All Rights Reserved            13               7/25/2012
Bed Allocation Results


Current state of bed allocation by
  Department
  Acuity
  Private/semi-private
  Other

Expected need – Short term – by
  Department
  Acuity
  Type
  Other factors
Bed Allocation schedules


Cleaning schedule with priorities
  When should each bed be cleaned, grouped by
  department
  Cleaning priority for each.

Discharge time impact on the schedule
  Effect of late discharge due to physician delays
  Schedule Adherence (Optimal vs current).
  Cause analysis of the delays.
Other benefits


              Better utilization of the OR
                      Increased capacity
                      Increased efficiency
                      Reduced “Waiting for OR” time
                      Improved staff efficiency

              ED efficiency improvement
                      Better predictability of the short term future state
                      improves staff and room scheduling.

www.createasoft.com         @Copyright 2012, CreateASoft, Inc. All Rights Reserved   16   7/25/2012
Results delivery


              Accessibility
                      On demand data availability
                      Web based – for intranet and tablet/smart phone
                      compatibility
                      Protected – availability based on need.

              Visual
                      Animated view for improved communication
                      Quick hover effect for fast data access.

www.createasoft.com         @Copyright 2012, CreateASoft, Inc. All Rights Reserved   17   7/25/2012
Examples




www.createasoft.com   @Copyright 2012, CreateASoft, Inc. All Rights Reserved   18   7/25/2012
www.createasoft.com   @Copyright 2012, CreateASoft, Inc. All Rights Reserved   19   7/25/2012
www.createasoft.com   @Copyright 2012, CreateASoft, Inc. All Rights Reserved   20   7/25/2012
Real-Time Bed Allocation with
               Dynamic Simulation
                                                  Hosni Adra
                                               CreateASoft, Inc.

                                                          Q&A


                      www.createasoft.com
            Process Improvement Solutions

www.createasoft.com    @Copyright 2012, CreateASoft, Inc. All Rights Reserved   21   7/25/2012

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Healthcare Simulation

  • 1. Real-Time Bed Allocation with Dynamic Simulation Hosni Adra CreateASoft, Inc. www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 1 7/25/2012
  • 2. Simulation Applications in Healthcare Patient Flow and Wait Time analysis Provider analysis OR Simulation and methods to improve OR efficiency ED Simulation Basic bed allocation implementation Clinics/Outpatient scheduling analysis And many more www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 2 7/25/2012
  • 3. Dynamic Simulation Dynamic simulation environment differs from standard environments… Highly interactive with fast model building capabilities. On-the-fly changes– Modify, Analyze, Optimize the model on the fly without the need to stop and restart the simulation Connectivity to external data systems during the simulation run Initial state loading based on current environment state. Dynamic model updates based on current constraints and flows. www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 3 7/25/2012
  • 4. The need for Dynamic Simulation Reduced time for model building Enable simulation for everyone within the organization Improve model accuracy Better optimization methods Improved analysis capability Provide “life to the model” beyond the initial simulation effort. www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 4 7/25/2012
  • 5. Why Bed Allocation? OR ED Patient Scheduling Arrivals Admittance Outpatient Transfers Scheduling Bed Availability Patient Experience And Hospital Efficiency www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 5 7/25/2012
  • 6. Looking in the wrong place? Is the ED the real problem? Are patients waiting due to bed availability? OR efficiency impact, patients waiting too long in PACU? Forecasting with Real Data ? 2 examples often missed in the analysis process. www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 6 7/25/2012
  • 7. Other impacts Revenue reduction. Increase in length of stay. Reduction in patient satisfaction. Efficiency reduction and increased utilization. Improper use of resources. Impact on staff and providers. And many more www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 7 7/25/2012
  • 8. Solution must have... Valid model representing the current state of the operation. Data – actual patient information data (HIPPA Compliant) Historical performance and data points. Staffing/provider constraint impact Ability to accurately forecast. Live model that can react to changes with minimum interaction. www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 8 7/25/2012
  • 9. Proposed Solution Historical EMR data Other Tracking systems Dynamic Simulation Live System – Constant Updates and monitoring Bed Allocation Needs Capacity constraints and Schedules Staff allocation and expected flow data www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 9 7/25/2012
  • 10. Data Side Seasonality Short term EMR Historical data Data Data Data Abstraction Layer Forecasting effect factors Staffing, spee Tracking d, efficiency Other factors Dynamic data Simulation Tracking data effect factors www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 10 7/25/2012
  • 11. Dynamic Simulation Models Bed Allocation (OR,ED,…) Rules Current State Scheduler Loader Results Data Store www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 11 7/25/2012
  • 12. Dynamic Simulation Detail 2 Methods to implement the simulation models Single model for Overall Hospital view. Multiple models connected through dynamic interface. Multiple models method provides Better model validation Faster delivery (multiple modelers) Ramped up implementation Distributed computing www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 12 7/25/2012
  • 13. Multiple Dynamic simulation models ED Model OR Model Bed Allocation Rules Model Dynamic Simulation Scheduler Other Related Bed Re-Allocation Rules Models Model www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 13 7/25/2012
  • 14. Bed Allocation Results Current state of bed allocation by Department Acuity Private/semi-private Other Expected need – Short term – by Department Acuity Type Other factors
  • 15. Bed Allocation schedules Cleaning schedule with priorities When should each bed be cleaned, grouped by department Cleaning priority for each. Discharge time impact on the schedule Effect of late discharge due to physician delays Schedule Adherence (Optimal vs current). Cause analysis of the delays.
  • 16. Other benefits Better utilization of the OR Increased capacity Increased efficiency Reduced “Waiting for OR” time Improved staff efficiency ED efficiency improvement Better predictability of the short term future state improves staff and room scheduling. www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 16 7/25/2012
  • 17. Results delivery Accessibility On demand data availability Web based – for intranet and tablet/smart phone compatibility Protected – availability based on need. Visual Animated view for improved communication Quick hover effect for fast data access. www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 17 7/25/2012
  • 18. Examples www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 18 7/25/2012
  • 19. www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 19 7/25/2012
  • 20. www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 20 7/25/2012
  • 21. Real-Time Bed Allocation with Dynamic Simulation Hosni Adra CreateASoft, Inc. Q&A www.createasoft.com Process Improvement Solutions www.createasoft.com @Copyright 2012, CreateASoft, Inc. All Rights Reserved 21 7/25/2012