Ensuring the feasibility of a $31 million OR expansion project: Capacity planning, system design, and patient flow with SIMUL8 simulation software
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Ensuring the feasibility of a $31 million OR expansion project: Capacity planning, system design, and patient flow Presenter: Todd Roberts, Memorial Health System The second workshop in our series will look at a recent project at Memorial Health System (MHS) in Illinois. Todd Roberts, System Director of Operations Improvement at MHS will discuss and demonstrate the use of discrete simulation modeling to analyze floor design and throughput for a new Rapid Clinical Examination provider model for a 70,000 annual visit, Level I trauma center emergency department at a 507 bed, tertiary, urban, academic medical center and flow for all aspects of architectural design proposal for $31 million dollar operating room expansion project, including pre-op admission, transport to OR, OR time, and post-anesthesia care units (PACU) for admitted and outpatient surgery. Through the use of discrete simulation modeling, Memorial has reduced length to stay for non-admitted patients in the emergency department by 27%, reduced percentage of patients leaving by without treatment by 50%, and released admit hold time by 37% while improving patient satisfaction from the 57th to 99th percentile (Press Ganey). In addition, Memorial has used simulation to determine the appropriate facilities layout for its new OR expansion project, determining that optimizing the flow of traffic will lead to a reduction of 30 minutes per case in wasted movement and waiting.
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Ensuring the feasibility of a $31 million OR expansion project: Capacity planning, system design, and patient flow with SIMUL8 simulation software
- 2. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888
- 3. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 1 800 547 6024 | +44 141 552 6888 • • •
- 4. Memorial Health System Discrete Event Simulation Todd S. Roberts, MBA, CLSSMBB System Director, Operations Improvement Memorial Health System May 15, 2013
- 5. Systems thinking is the ability to see things as a whole (or holistically), including the many different types of relationships between the diverse elements of a complex system Necessary component of “learning organizations” Takes cause-and-effect thinking to a higher level and encourages the user to see not just the linear causal connections but also the web of causal interconnections that come into play in real systems “The Fifth Discipline”
- 6. “Adjusting the system or process inputs to produce the best possible average response with minimum variability” System Optimization
- 7. The sensitive dependence on initial conditions, where a small change at one place can result in large differences to a later state. Butterfly Effect
- 8. Three types of failures in complex systems: – Procedural • Failure to adhere to/execute a defined process • Single, obvious mistakes • Special-cause variation • Plan, Do, Check, Act or corrective action – Engineered • People, process, materials • Common-cause variation • Defined processes • Lean Six Sigma projects – System • Complex interactions between processes and risk factors • Difficult to understand and pinpoint cause and effect relationships • Discrete event simulation Failure in Complex Systems
- 9. Simulated floor design and throughput for new Rapid Clinical Examination provider model for a 70,000 annual visit, Level I trauma center emergency department at a 507 bed, tertiary, urban, academic medical center Simulation was constructed using floor layout schematic and provider resource models based upon historic hourly ED arrival (Poisson) and service distribution rates (exponential) for high, mid, and low acuity patients as well as admitted vs. discharged dispensation ED Flow Redesign Project
- 10. Goals of the simulation model were as follows: – Determine the most efficient model for routing patients through the system (high acuity patients to main ED, low acuity patients to rapid clinical examination) – Determine the number of provider resources necessary for staffing based upon patient distribution – Determine primary macro factors affecting length of stay for all patients – Identify process constraints and bottlenecks – Identify factors contributing to increased patient wait time and patients leaving without treatment (LWOT) ED Simulation Goals
- 11. Determined the appropriate routing model for patients to the main ED and the Rapid Clinical Examination process The provider mix was adjusted to accommodate peak volumes throughout the day in an effort to minimize wait times and LWOTS A number of Lean Six Sigma projects were chartered based upon the findings of the Simulation model, including time from imaging complete to discharge, lab turnaround time, and CT utilization and turnaround time Simulation Results
- 12. EMERGENCY DEPARTMENT RAPID CLINICAL EXAMINATION MODEL POST-IMPROVEMENT DATA
- 17. ED Admitted Patient Average Length of Stay (minutes) 2nd consecutive month below 200 minutes & 1st month below 100 minutes
- 19. Emergency Department Patient Satisfaction over 80th%ile for 3nd consecutive month & 2nd consecutive month at 98th%ile or above . 2nd quarter FY 2013 99th%ile .
- 20. – May 2012 – RCE Launch – July 1, 2012 – RCE Fully implemented 7 days/week – August 17, 2012 – RCE Red Flag criteria change (based on Simulation) – January 21, 2013 – 4th lane of RCE added (Based on Simulation) – April 9, 2013 – ED facilities remodeled to support process flow Key Process Changes
- 21. Simulate flow for all aspects of architectural design proposal for $31 million dollar operating room expansion project, including pre-op admission, transport to OR, OR time, and post- anesthesia care units (PACU) for admitted and outpatient surgery Test assumptions for capacity based on an expansion of 5 operating rooms (and pre- op/PACU beds) and increased volumes of 15% over the next 5 years OR Renovation Design Simulation
- 22. 2 Elevators 3 Elevators Operating Room Opportunity Cost = $54/minute
- 23. Identified process bottlenecks and determined that with a surge of patients transported to the OR for first and second-case starts, that two elevators from the pre-op holding area to the ORs is not adequate for flow, and will lead to staff, physician, and patient dissatisfaction while increasing overall variation by 30 minutes per case throughout the day. Decision was made to add a third elevator to the design to satisfy flow demand The discovery of downstream increase in variation could not have been achieved and recognized using static waiting line models. Simulation Results
- 24. Lean Six Sigma projects have been chartered to streamline scheduling processes and OR room turnover processes to further reduce variation and increase capacity Studies conducted for projected increased volume year over year have allowed the building of adequate facilities for the next 20 years Next Steps
- 25. Requires deep process understanding (avoid tampering) Creates a shared visual understanding of the process for all parties Allows for observational analysis and modification without physical intervention in a complex environment (offline trial and error) Supports improved decision-making through management by fact Discrete Event Simulation Benefits