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

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

3. 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

4. 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

5. 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

6. 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.

7. SIMULATION PREPARATION

8. 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

9. 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

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

11. Process Flow

12. Simulation Preparation

13. Activities captured for Electronic Data Validation Simulation Simulation Preparation Data Collection

14. 34% 42% 24% Baseline 63.4 (min) Data Collection Simulation Preparation

15. Data Collection Simulation Preparation

16. BUILDING THE SIMULATION

17. Building the Simulation

18. Insert the schedule of all labor resources represented in the model

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

20. Building the Simulation

22. Initial Results

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

24. 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

25. Supplementary MD Anderson Volume of Clinical Activity 2

26. Supplementary

28. -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