Page 137 - HA Convention 2015

Symposiums

S4.3 Getting the Right Patient to the Right Place 14:30 Convention Hall A

Using Simulation to Explore Interactions between Workflow, Staffing and Waiting Times in a Hong Kong
Emergency Department
Graham C
Department of Emergency Medicine, The Chinese University of Hong Kong, Hong Kong

Background Tuesday, 19 May

Like most healthcare systems, Hong Kong has Emergency Departments (ED) at all general hospitals throughout the territory.
The EDs are available at all times, and as well as providing an essential emergency role they provide primary care to a
substantial number of patients. The aging population and increasing complexity of healthcare continues to increase the
workload in Emergency Departments. Many departments have had to cope with fewer medical staff recently. We wanted
to develop methods to model patient flows and throughput; improve patients’ experience (e.g. shorten patients’ waiting
times); utilise valuable resources (particularly staff) as efficiently as possible; and evaluate possible changes in patient care
processes.

Methods

This study was based in the ED of Prince of Wales Hospital (PWH, census 150,000 patients), the teaching hospital of The
Chinese University of Hong Kong (CUHK), which serves Shatin and the Northeast New Territories (population 1.5 million).
PWH is a tertiary centre for trauma, stroke, cardiothoracic surgery, neurosurgery, and oncology. We partnered with our
Systems Engineering colleagues at the CUHK and we built our model on Arena simulation software. We captured all the
relevant processes (triage, consultations, laboratories, etc.) and the complexities of intertwining and re-entrant patient-
flows. Standard input parameters included arrival rates, probability distributions of service times, available resources and
schedules of doctors and nurses. Outputs included performance measures such as patients’ waiting time, queue lengths,
and utilisation of doctors’ time.

Results

We used our simulation model to investigate the following possibilities: increases in the arrival rates of patients; adding an
extra doctor in different areas of the ED, or in different time slots. Full results will be presented in the convention.

Discussion

We were able to build a simulation model for the daily operations of the ED at the Prince of Wales Hospital in Hong Kong, and
we solved the problem of data scarcity by using a parameters estimation method. The simulation model can evaluate impacts
on the system by making possible changes to improve patient care. This could help hospital clinicians and managers to
make decisions based on evidence rather than guesswork, and permit more rational deployment of staff and resources when
demands exceed capacity.

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