Using Discrete Event Simulation to Improve Diagnostic Imaging Resource Utilization Pheba Philip Ashley Robinson June 2014

 MD Anderson & the Breast Diagnostic Center  Problem & Aim Statement  Simulation Preparation  Building the Simulation  Initial Results  Next Steps  Challenges Outline

Background on MD Anderson  Located in Houston, TX  Found in 1941  20,000 Employees (1,600 faculty)  650 inpatient beds  1.3 M outpatient visits  Provided care to 120,000 patients in 2013  Ranked Number 1 in cancer care by U.S. News and World Report

Background Breast Diagnostic Imaging  Sub-specialty of the Department of Diagnostic Radiology  Biopsies performed and Images taken of the breast to identify cancer  Over 54,000 procedure performed

Why use Simulation? Understanding of complex systems Identification of constraints in the system (patient flow, staff utilization, resource management) Testing & experimentation Visual tool to enhance communication FlexSim Healthcare used for the simulation model

Problem & Aim Statement Patients are experiencing long wait times and resources are under utilized in the breast diagnostic center. The aim is to build a simulation model that identifies opportunities to reduce patient wait time and better utilize resources by April 2014.

SIMULATION PREPARATION

Simulation Preparation Identify the Scope 1.Wait time of patients with appointments in Mammo and US 2.Utilization of labor and equipment 3.Scheduling of patients, radiologist, and techs

Center Information Two Modalities: Diagnostic Mammo & Ultrasound (US) 9 US Techs / 9 Mammo Techs 3 US Radiologist / 2 Diagnostic Mammo Radiologist 2 Diagnostic Assistants 3 RNs 8 Breast US Rooms/ 8 Diagnostic Mammo Rooms Simulation Preparation

Four Patient Flow Charts Diagnostic Mammo Ultrasound Diagnostic to Mammo Stereotactic Simulation Preparation

Process Flow

Simulation Preparation

Activities captured for Electronic Data Validation Simulation Simulation Preparation Data Collection

34% 42% 24% Baseline 63.4 (min) Data Collection Simulation Preparation

Data Collection Simulation Preparation

BUILDING THE SIMULATION

Building the Simulation

Insert the schedule of all labor resources represented in the model

Building the Simulation Wait Area Entrance & Exit Radiologist Reading Room Diagnostic Mammo Ultrasound Diagnostic Mammo Patient Path

Building the Simulation

Initial Results

Next Steps Validate simulation results Recommend changes based on simulation output Create new simulation with recommended changes

Before you begin… What are you simulating? Are you simulating something you can’t change? Are you attempting to simulate EVERYTHING? EEK! Validate, Validate, VALIDATE

Supplementary MD Anderson Volume of Clinical Activity 2

Supplementary

-Key Stats -LOS -Average Wait Times -Volumes -Operating Hours (closing time) -Evaluation -Modality concerns -Bottlenecks? -Space Sufficient? -Utilization -What-If Scenarios Projected Demand DI Processes & Service Times Facility Layout Simulation Model Supplementary