Using Discrete Event Simulation Approach to Reduce Waiting Times in Computed Tomography Radiology Department
Authors: Mwafak Shakoor
The purpose of this study was to reduce patient waiting times, improve system throughput and improve resources utilization in radiology department. A discrete event simulation model was developed using Arena simulation software to investigate different alternatives to improve the overall system delivery based on adding resource scenarios due to the linkage between patient waiting times and resource availability. The study revealed that there is no addition investment need to procure additional scanner but hospital management deploy managerial tactics to enhance machine utilization and reduce the long waiting time in the department.
Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1338044Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF
 S. Walston, Y. Al-Harbi, and B. Al-Omar, "The changing face of healthcare in Saudi Arabia," Annals of Saudi Medicine, 28:243–250, 2008.
 Shankar Purbey, Kampan Mukherjee, and Chandan Bhar, "Performance measurement system for healthcare processes," International Journal of Productivity and Performance Management, Vol. 56, Iss: 3, pp. 241 – 251, 2007.
 Key indicators. Central Department of Statistics and Information, Saudi Arabia (online database) (http://www.cdsi.gov.sa/english).
 J. B. Jun, S. H. Jacobson, and J. R. Swisher, “Application of discreteevent simulation in health care clinics: A survey,” J. Oper. Res. Soc., Vol. 50, No. 2, pp. 109–123, Feb. 1999.
 P. C. O'Kane, "A simulation model of a diagnostic radiology department," European Journal of Operation Research, Vol, 6, pp. 38 – 45, 1981.
 Klafehn, "Impact points in patient flows through a radiology department provided through simulation," Proceedings of the 1987 Winter Simulation Conference, Institute of Electrical and Electronics Engineers, Atlanta, Georgia, USA, pp. 914 – 918, 14 – 16 December.
 M. A. Coffin, G. Lassiter, B. Killingsworth, and J. W. Kleckley, "A simulation model of an X – ray facility," 1993 SCS Western Multiconference on Simulation: Simulation in the Health Sciences and Services, Society for Computer Simulation, La Jolla, California, USA, pp. 3 – 7, 17 – 20 January 1993.
 M. A. Centeno, C. Albacete, D. O. Terzano, M. Carrillo, and T. Ogazon, "A simulation study of the radiology department at JMH," Proceedings of the 2000Winter Simulation Conference, Institute of Electrical and Electronics Engineers, Orlando, Florida, USA, pp. 1978 – 1984, 10 – 13 December 2000.
 J. Banks, J. S. Carson II, B. L. Nelson, and D. M. Nicol, Discrete event system simulation, 4 edition, Prentice Hall, New Jersey, USA, 2004.
 Averill M. Law, and W. David, Simulation Modelling and Analysis, 3RD edition, McGraw Hill Higher Education, New York, USA, 2000.
 David Kelton, Randall Sadowski, and Nancy Zupick, Simulation with Arena, 5TH edition , McGraw-Hill, New York, USA, 2009.
 S. H. Jacobson, S. N. Hall, and J. R. Swisher, "Discrete-event simulation of health care systems, patient flow: reducing delay in healthcare delivery", Int Ser Oper Res Manag Sci, 91, pp. 211–52, 2006.
 J. M. H. Vissers, "Patient flow-based allocation of inpatient resources: A case study," European Journal of Operational Research, vol. 105, pp. 356-370, 1998.
 L. Moreno, R. M. Aguilar, C. A. Martin, J. D. Pineiro, J. I. Estevez, J. F. Sigut, J. L. Sanchez, and V. I. Jimenez, "Patient-centered simulation tool for aiding in hospital management," Simulation Practice and Theory, vol. 7, pp. 373-393, 1999.
 P. R. Harper, "A Framework for Operational Modelling of Hospital Resources," Health Care Management Science, vol. 5, pp. 165-173, 2002.
 T. R. Rohleder, and K. J. Klassen, "Rolling Horizon Appointment Scheduling: A Simulation Study," Health Care Management Science, vol. 5, pp. 201-209, 2002.
 P. R. Harper, and A. K. Shahani, "Modelling for the planning and management of bed capacities in hospitals," Journal of the Operational Research Society, vol. 53, pp. 11-18, 2002.
 J. K. Cochran, and A. Bharti, "A multi-stage stochastic methodology for whole hospital bed planning under peak loading," International Journal of Industrial and Systems Engineering, vol. 1, pp. 8-36, 2006.
 D. Sundaramoorthi, V. C. P. Chen, J. M. Rosenberger, S. B. Kim, and D. B. Behan, A data-integrated simulation model to evaluate nurse-patient assignments, Technical Report IMSE 06-05, The University of Texas at Arlington, 2006.
 W. J. Gutjahr, and M. S. Rauner, "An ACO algorithm for a dynamic regional nurse-scheduling problem in Austria," Computers & Operations Research, vol. 34, pp. 642- 666, 2007.
 J. M. H. Vissers, I. J. B. F. Adan, and N. P. Dellaert, "Developing a platform for comparison of hospital admission systems: An illustration," European Journal of Operational Research, vol. 180, pp. 1290-1301, 2007.
 I. K. Altinel, and E. Ulas, "Simulation modeling for emergency bed requirement planning," Annals of Operations Research, vol. 67, pp. 183- 210, 1996.
 J. T. Blake, and M. W. Carter, "An analysis of emergency room wait time issues via computer simulation," INFOR, vol. 34, pp. 263–273, 1996.
 C. J. Gonzalez, M. Gonzalez, and N. M. Rios, "Improving the quality of service in an emergency room using simulation-animation and total quality management," Computers & Industrial Engineering, vol. 33, pp. 97-100, 1997.
 A. Bagust, M. Place, and J. W. Posnett, "Dynamics of bed use in accommodating emergency admissions: stochastic simulation model," BMJ, vol. 319, pp. 155-158, 1999.
 D. C. Lane, C. Monefeldt, and J. V. Rosenhead, "Looking in the wrong place for healthcare improvements: A system dynamics study of an accident and emergency department," Journal of the Operational Research Society, vol. 51, pp. 518-531, 2000.
 R. Ashton, L. Hague, M. Brandreth, D. Worthington, and S. Cropper, "A simulation-based study of a NHS Walk-in Centre," Journal of the Operational Research Society, vol. 56, pp. 153-161, 2005
 D. Sinreich, and Y. N. Marmor, "Emergency Departments Operations: The Basis for Developing a Simulation Tool," IIE Transactions, vol. 37, pp. 233-245, 2005.
 J.-Y. Yeh, and W.-S. Lin, "Using simulation technique and genetic algorithm to improve the quality care of a hospital emergency department," Expert Systems with Applications, vol. 32, pp. 1073-1083, 2007.
 N. R. Hoot, L. J. Leblanc, I. Jones, S. R. Levin, C. Zhou, C. S. Gadd, and D. Aronsky, "Forecasting Emergency Department Crowding: A Discrete Event Simulation," Annals of Emergency Medicine, vol. 52, pp. 116-125, 2008.
 Nabeel Mandahawi; Sameh Al-Shihabi; Abdallah A. Abdallah, and Yousuf M. Alfarah, "Reducing waiting time at an emergency department using design for Six Sigma and discrete event simulation," Int. J. Six Sigma and Competitive Advantage, vol. 6, Nos. 1/2, pp. 91 – 104, 2010.
 Lee-Min Wang, Shao-Jen Weng, Chun-Yueh Chang, Bing-Chuin Cheng, and Shu Ting Kwong, "Simulation Optimization for Emergency Department Resources Allocation," Proceedings of the 2011 Winter Simulation Conference, pp. 1231 – 1238, 2011.
 Zhen Zeng, Xiaoji Ma, Yao Hu, Jingshan Li, and Deborah Bryant, "A simulation study to improve quality of care in the emergency department of a community hospital," Journal of emergency nursing, vol. 38, issue 4, pp. 322 – 328, 2012.
 E. El-Darzi, C. Vasilakis, T. Chaussalet, and P. H. Millard, "A simulation modelling approach to evaluating length of stay, occupancy, emptiness and bed blocking in a hospital geriatric department," Health Care Management Science, vol. 1, pp. 143-149, 1998.
 J. Bowers, and G. Mould, "Ambulatory Care and Orthopaedic Capacity Planning," Health Care Management Science, vol. 8, pp. 41-47, 2005.
 L. V. Green, S. Savin, and B. Wang, "Managing Patient Service in a Diagnostic Medical Facility," Operations Research, vol. 54, pp. 11-25, 2006.
 J. P. Oddoye, D. F. Jones, M. Tamiz, and P. Schmidt, "Combining simulation and goal programming for healthcare planning in a medical assessment unit," European Journal of Operational Research, vol. 193, pp. 250-261, 2009.
 J. C. Ridge, S. K. Jones, M. S. Nielsen, and A. K. Shahani, "Capacity planning for intensive care units," European Journal of Operational Research, vol. 105, pp. 346-355, 1998.
 S.-C. Kim, I. Horowitz, K. K. Young, and T. A. Buckley, "Analysis of capacity management of the intensive care unit in a hospital," European Journal of Operational Research, vol. 115, pp. 36-46, 1999.
 S.-C. Kim, I. Horowitz, K. K. Young and T. A. Buckley, "Flexible bed allocation and performance in the intensive care unit," Journal of Operations Management, vol. 18, pp. 427-443, 2000.
 S.-C. Kim, and I. Horowitz, "Scheduling hospital services: the efficacy of electivesurgery quotas," Omega, vol. 30, pp. 335-346, 2002.
 N. Litvak, M. Van Rijsbergen, R. J. Boucherie and M. Van Houdenhoven, "Managing the overflow of intensive care patients," European Journal of Operational Research, vol. 185, pp. 998-1010, 2008.
 W. E. Mcaleer, J. A. Turner, D. Lismore and I. A. Naqvi, "Simulation of a hospital’s theatre suite," Journal of Management in Medicine, vol. 9, pp. 14-26, 1995.
 F. Dexter, A. Macario, R. D. Traub, M. Hopwood, and D. A. Lubarsky, "An Operating Room Scheduling Strategy to Maximize the Use of Operating Room Block Time: Computer Simulation of Patient Scheduling and Survey of Patients," Preferences for Surgical Waiting Time. Anesth Analg, vol. 89, pp. 7-20, 1999.
 J. E. Everett, "A Decision Support Simulation Model for the Management of an Elective Surgery Waiting System," Health Care Management Science, vol. 5, pp. 89-95, 2002.
 D. C. Tyler, C. A. Pasquariello, and C.-H. Chen, "Determining Optimum Operating Room Utilisation," Anesth Analg, vol. 96, pp. 1114-1121, 2003.
 J. Bowers, and G. Mould, "Managing uncertainty in orthopaedic trauma theatres," European Journal of Operational Research, vol. 154, pp. 599- 608, 2004.
 A. Sciomachen, E. Tanfani, and A. Testi, "Simulation model for optimal schedules of operating theatres," International Journal of Simulation, vol. 6, pp. 26-34, 2005.
 A. Jebali, A. B. Hadj Alouane, and P. Ladet, "Operating rooms scheduling," International Journal of Production Economics, vol. 99, pp. 52-62, 2006.
 M. Lamiri, X. Xie, A. Dolgui. and F. Grimaud, "A stochastic model for operating room planning with elective and emergency demand for surgery," European Journal of Operational Research, vol. 185, pp. 1026-1037, 2008.
 B. Cardoen, and E. Demeulemeester, "Evaluating the capacity of clinical pathways through discrete-event simulation," FETEW Research Report KBI_0724, 2007.
 C. Vasilakis, B. G. Sobolev, L. Kuramoto, and A. R. Levy, "A simulation study of scheduling clinic appointments in surgical care: individual surgeon versus pooled lists," Journal of the Operational Research Society, vol. 58, pp. 202-211, 2007.
 J. M. Lehtonen, J. Kujala, J. Kouri, and M. Hippelainen, "Cardiac surgery productivity and throughput improvements," International Journal of Health Care Quality Assurance, vol. 20, pp. 40-52, 2007.
 S. C. K. Chu, and L. Chu, "A modeling framework for hospital location and service allocation," International Transactions in Operational Research, vol. 7, pp. 539-568, 2000.
 C. Vasilakis, and E. El-Darzi, "A simulation study of the winter bed crisis," Health Care Management Science, vol. 4, pp. 31-36, 2001.
 F. Pasin, M. H. Jobin, and J. F. Cordeau, "An application of simulation to analyse resource sharing among health-care organizations," International Journal of Operations & Production Management, vol. 22, pp. 381-393, 2002.
 R. Davies, P. Roderick, and J. Raftery, "The evaluation of disease prevention and treatment using simulation models," European Journal of Operational Research, vol. 150, pp. 53-66, 2003.
 F. Huarng, and M. H. Lee, "Using simulation in out-patient queues: a case study," International Journal of Health Care Quality Assurance, vol. 9, pp. 21-25, 1996.
 J. R. Swisher, S. H. Jacobson, J. B. Jun, and O. Balci, "Modeling and analyzing a physician clinic environment using discrete-event (visual) simulation," Computers and Operations Research, vol. 28, pp. 105-125, 2001.
 V. De Angelis, G. Felici, and P. Impelluso, "Integrating simulation and optimisation in health care centre management," European Journal of Operational Research, vol. 150, pp. 101-114, 2003.
 L. W. Robinson, and R. R. Chen, "Scheduling doctors' appointments: optimal and empirically-based heuristic policies," IIE Transactions, vol. 35, pp. 295 – 307, 2003.
 P. R. Harper, and H. M. Gamlin, "Reduced outpatient waiting times with improved appointment scheduling: a simulation modelling approach," OR Spectrum, vol. 25, pp. 207-222, 2003.
 S. Dodds, "Designing improved healthcare processes using discrete event simulation," The British Journal of Healthcare Computing & Information Management, vol. 22, pp. 14-16, 2005.
 A. K. A. Wijewickrama, "Simulation analysis for reducing queues in mixed patients' outpatient department," International Journal of Simulation Modelling, vol. 5, pp. 56-68, 2006.
 T. Rohleder, D. Bischak, and L. Baskin, "Modeling patient service centers with simulation and system dynamics," Health Care Management Science, vol. 10, pp. 1-12, 2007.
 S. C. K. Chu, C. K. Y. Lin, and S. S. Lam, "Hospital lift system simulator: A performance evaluator-predictor," European Journal of Operational Research, vol. 146, pp. 156-180, 2003.
 A. K. A. Wijewickrama, "Optimum number of parking spaces in a hospital: a simulation analysis," International Journal of Simulation Modelling, vol. 83, pp. 132-141, 2004.
 R. Haijema, J. Van Der Wal, and N. M. Van Dijk, "Blood platelet production: Optimisation by dynamic programming and simulation," Computers & Operations Research, vol. 34, pp. 760-779, 2007.
 R. E. Shannon, Systems Simulation: The Art and Science, prentice – Hall, Englewood Cliffs, NJ, USA, 1975.
 A. Mahachek, "An introduction to patient flow simulation for healthcare managers," Journal of the Society for Health Systems, vol. 3, No. 3, pp. 73 – 81, 1992.