A Simulation Model for A Simulation Model for Bioterrorism Preparedness in Bioterrorism Preparedness in An Emergency RoomAn Emergency Room

Lisa PatvivatsiriDepartment of Industrial Engineering

Texas Tech University

Presented by Hoang BuiComputer Science DepartmentMidwestern State University

OverviewOverviewIntroductionWhy uses simulation?Emergency room processSimulation modelExperimental scenario analysisQuestion

IntroductionIntroductionBioterrorism threats after

9/11/2001Requirement for a quick

response planLack of prior knowledge

Why uses simulation?Why uses simulation?ValidityReal-time processingUser interfaceFlexibilityEasy to use

Emergency room processEmergency room processMedium size hospital in Lubbock,

TexasSome definitions:

◦Pod: a section in the ER Pod A: 19 beds Pod B: 12 beds Pod C: 10 beds 19 additional beds in hall way

Severe patientsSerious injured patientsWalking-wounded patientsCharge nurses

Emergency room processEmergency room process

Arrival processArrival processWalk-In Patient

◦723 patients per week◦IAT = 13.94 minutes

Ambulance◦5 patients per day◦IAT = 288 minutes

Helicopter◦1 per week◦IAT = 10080 minutes

Triage and Pod Triage and Pod assignmentassignmentWalk-In patient:

◦Go in to triage process 4 triage nurses Service time: triangular

distribution(20,23,25)

◦Send to Pod A, B or CAmbulance and Helicopter

patient:◦Send to Pod A

Treatment processTreatment processResource:

◦Pod C: 11:00AM – 11:00 PM◦6 treatment nurses per pod◦3 shared medical doctors

Bedside registration by a charge nurse

Initial assessment by a treatment nurse

MD evaluation◦86 of 723 patients require further lab test

Treatment processTreatment process

Simulation modelSimulation model

Simulation modelSimulation modelSoftware:

◦Flexsim 2.6◦Input and output spreadsheet in Excel

2003Assumption:

◦Testing equipment is not included◦Testing time is triangular

distribution(95,156,192)◦Doctors and nurses in Pod C work overtime◦A patient releases his bed only when

leaving

Simulation modelSimulation modelValidation and Verification

◦Meet frequently with E.R. director and staff

◦Data collected by E.R. supervisor◦7 days warm-up follow by 30 days

run◦10 replications◦Average time in system:202.42

minutes(simulation) vs. 207.42 minutes (actual)

Experimental scenario Experimental scenario analysisanalysis

Outbreak of contagious disease:◦432 people are infected during 72

hours◦Addition patients every 10 minutes

during 1st 72 hours

Experimental scenario Experimental scenario analysisanalysis

Experimental scenario Experimental scenario analysisanalysis

Proposed new strategy◦Move 10 beds from Pod A to Pod B,

and 12 beds in the hallway to Pod C◦Move 2 treatment nurses from Pod A

to Pod C◦Add 4 treatment nurses to Pod B◦Add 2 more MD

Experimental scenario Experimental scenario analysisanalysis

Experimental scenario Experimental scenario analysisanalysis

Experimental scenario Experimental scenario analysisanalysis

QuestionsQuestions

ReferenceReferenceA Simulation Model for

Bioterrorism Preparedness in An Emergency Room by Lisa Patvivatsiri, In Proceedings of the 2006 Winter Simulation Conference.