title: Reducing postponements of elective pediatric cardiac procedures: analysis and implementation of a discrete event simulation model.
abstract: BACKGROUND
  This study describes the use of discrete event simulation (DES) to model and analyze a large academic pediatric and test cardiac center. The objective was to identify a strategy, and to predict and test the effectiveness of that strategy, to minimize the number of elective cardiac procedures that are postponed because of a lack of available cardiac intensive care unit (CICU) capacity.
  
  
  METHODS
  A DES of the cardiac center at The Children's Hospital of Philadelphia was developed and was validated by use of 1 year of deidentified administrative patient data. The model was then used to analyze strategies for reducing postponements of cases requiring CICU care through improved scheduling of multipurpose space. Each of five alternative scenarios was simulated for ten independent 1-year runs.
  
  
  RESULTS
  Reductions in simulated elective procedure postponements were found when a multipurpose procedure room (the hybrid room) was used for operations on Wednesday and Thursday, compared with Friday (as was the real-world use). The reduction Wednesday was statistically significant, with postponements dropping from 27.8 to 23.3 annually (95% confidence interval 18.8-27.8). Thus, we anticipate a relative reduction in postponements of 16.2%. Since the implementation, there have been two postponements from July 1 to November 21, 2014, compared with ten for the same time period in 2013.
  
  
  CONCLUSIONS
  Simulation allows us to test planned changes in complex environments, including pediatric cardiac care. Reduction in postponements of cardiac procedures requiring CICU care is predicted through reshuffling schedules of existing multipurpose capacity, and these reductions appear to be achievable in the real world after implementation.
authors: Office of Safety and Medical Operations, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: dayt@email.chop.edu.
authors: Theodore Eugene
authors: TE
authors: Day
authors: Office of Safety and Medical Operations, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Sandeep
authors: S
authors: Sarawgi
authors: The Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors: Alexis
authors: A
authors: Perri
authors: The Cardiac Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Anesthesia and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Susan C
authors: SC
authors: Nicolson
mesh_terms: D000046:Academic Medical Centers; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D017598:Efficiency, Organizational; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D017146:Models, Organizational; D010372:Pediatrics; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D015143:Philadelphia; D013997:Time Factors