1. BROUGHT TO YOU BY LEADING EDGE GROUP Welcome Using Simulation Modelling to improve the performance of Healthcare Facilities

2. BROUGHT TO YOU BY LEADING EDGE GROUP Review use and benefits of simulation modelling and how it can be used in healthcare applications. Review a case study of a simulation model of an emergency department. Examine wider applications of modelling to initiate and drive improvement programmes. Learning Outcomes:

3. BROUGHT TO YOU BY LEADING EDGE GROUP Lean improvement programmes often focused on an area in crisis or in need of significant level of improvement Resolution of crisis involves multi-faceted approach including: – Lean Initiatives – Process Change – Staff & Organisation Changes Where to Start? Implementing Lean: Where to Start

4. BROUGHT TO YOU BY LEADING EDGE GROUP Computerised Dynamic Model of an area 3D Animated flowchart Model accurately represents measured “As Is” situation: – Patient Arriving – Queuing – Treatment – Departing/Referral, etc Use the model to quantify the impact of the proposed improvements What is Simulation?

5. BROUGHT TO YOU BY LEADING EDGE GROUP Letterkenny General Hospital designing a new Emergency Department – Census 31,435 attendances per annum – Currently 90% of patients being discharged within 6 Hr target. – 7% attendance increase year on year – Patients currently being treated in inappropriate facilities, eg, corridors Mission: Achieve “100% 6 Hours In/Out” Apply Improvements to both current & proposed Emergency Department Case Study: Simulation of an Emergency Department

6. BROUGHT TO YOU BY LEADING EDGE GROUP Data Gathering to build model Direct observed verified data, HIS data, Patient process flows charted, 500 individuals mapped, monitored, timed, verified through ED HIS: # Patients arriving Patient arrival time profile Service designation (Medical, Emergency, etc) % / # of Patients Admitted by service Measured Data Patient Triage profile Treatment Pathways % Patients XR, Bloods % of Patients discharged/ cross referred % of Patients treated by service Treatment times observed

7. BROUGHT TO YOU BY LEADING EDGE GROUP Reception/ Registration Triage Tests Meet Emergency Dept Dr Discharge Refer Meet Emergency Dept Dr Discharge Refer Meet Medical/ Spec Dr Queue Tests Discharge Refer Meet Medical/ Spec Dr Discharge Refer Queue Admit Wait Move to Hospital Patient Arrival Queue Develop Process Map

8. BROUGHT TO YOU BY LEADING EDGE GROUP Data Input through Excel

9. BROUGHT TO YOU BY LEADING EDGE GROUP The Model: currently running

10. BROUGHT TO YOU BY LEADING EDGE GROUP Patient Treatment Time Emergency Pt60% Wait Medical Pt74% WaitInitial &Terminal queues Blocked cubicles  Process blockages

11. BROUGHT TO YOU BY LEADING EDGE GROUP Ask the Model “What if ?” Quantify the Impact of Proposed Changes – Additional Facilities Treatment Cubicles X-Ray – Bed availability (Reduce admit delay) – Process changes Advanced Nurse Practitioner See & Treat Model – Additional Staff

12. BROUGHT TO YOU BY LEADING EDGE GROUP Examine the Impact of Additional X-Ray Facilities

13. BROUGHT TO YOU BY LEADING EDGE GROUP Simulation Quantifies Benefits of each Potential Solution

14. BROUGHT TO YOU BY LEADING EDGE GROUP Case Study: Key Learning Points Simulation Model Quantified Impact of a Range of Potential solutions. Enabled Clear & Decisive Decision Making. Operational Changes, Staff Changes, Capital Investment all considered.

15. BROUGHT TO YOU BY LEADING EDGE GROUP Simulation Fit within Lean Data driven solutions tested before implementation. Test “What If” scenarios. Move debate from abstract opinions  data driven decisions.

16. BROUGHT TO YOU BY LEADING EDGE GROUP Potential Applications Highly dynamic environments Complex process, multiple operations Test solutions in safe environment Example Areas – Emergency Department – Operating Theatres – Outpatients