title: Using discrete event computer simulation to improve patient flow in a Ghanaian acute care hospital.
abstract: OBJECTIVE
  Crowding and limited resources have increased the strain on acute care facilities and emergency departments worldwide. These problems are particularly prevalent in developing countries. Discrete event simulation is a computer-based tool that can be used to estimate how changes to complex health care delivery systems such as emergency departments will affect operational performance. Using this modality, our objective was to identify operational interventions that could potentially improve patient throughput of one acute care setting in a developing country.
  
  
  METHODS
  We developed a simulation model of acute care at a district level hospital in Ghana to test the effects of resource-neutral (eg, modified staff start times and roles) and resource-additional (eg, increased staff) operational interventions on patient throughput. Previously captured deidentified time-and-motion data from 487 acute care patients were used to develop and test the model. The primary outcome was the modeled effect of interventions on patient length of stay (LOS).
  
  
  RESULTS
  The base-case (no change) scenario had a mean LOS of 292 minutes (95% confidence interval [CI], 291-293). In isolation, adding staffing, changing staff roles, and varying shift times did not affect overall patient LOS. Specifically, adding 2 registration workers, history takers, and physicians resulted in a 23.8-minute (95% CI, 22.3-25.3) LOS decrease. However, when shift start times were coordinated with patient arrival patterns, potential mean LOS was decreased by 96 minutes (95% CI, 94-98), and with the simultaneous combination of staff roles (registration and history taking), there was an overall mean LOS reduction of 152 minutes (95% CI, 150-154).
  
  
  CONCLUSIONS
  Resource-neutral interventions identified through discrete event simulation modeling have the potential to improve acute care throughput in this Ghanaian municipal hospital. Discrete event simulation offers another approach to identifying potentially effective interventions to improve patient flow in emergency and acute care in resource-limited settings.
authors: University of Cincinnati, College of Medicine, Cincinnati, OH 45229.
authors: Allyson M
authors: AM
authors: Best
authors: Division of Emergency Medicine, Center for Global Health, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229.
authors: Cinnamon A
authors: CA
authors: Dixon
authors: Department of Operations, Business Analytics and Information Systems, University of Cincinnati, Cincinnati, OH 45221.
authors: W David
authors: WD
authors: Kelton
authors: Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45267-0769.
authors: Christopher J
authors: CJ
authors: Lindsell
authors: Department of Emergency Medicine, Vanderbilt University, Nashville, TN 37232. Electronic address: mward04@gmail.com.
authors: Michael J
authors: MJ
authors: Ward
mesh_terms: D003198:Computer Simulation; D003441:Crowding; D003906:Developing Countries; D004636:Emergency Service, Hospital / Q000458:organization & administration* / Q000592:standards; D005869:Ghana; D006801:Humans; D007902:Length of Stay; D058996:Quality Improvement / Q000458:organization & administration; D013997:Time Factors