Acil Servis Sürecinin Sistem Dinamiği Simülasyon Yöntemiyle Analizi

Abstract

The emergency department, which is one of the most significant units of hospitals, offers health services to patients 7 days 24 hours. It is vital that emergency services provide uninterrupted service effectively and efficiently under changing conditions (unexpected patient density, patient health status, etc.). In the emergency department where complexity, uncertainty and patient density are high, there are some difficulties due to disruptions and deficiencies in process flows. Many of the difficulties are related to waiting times of patients in the emergency department. Inadequate or incorrect allocation of staff and physical resources of the hospital against patient intensity causes long waiting periods and patients cannot receive efficient and effective service from the emergency department. Therefore, studies on optimize the patient process flow in this department becomes important.

In the emergency department, the rate of instant patient entry shows high dynamic variability and it is thought that the problems caused by this unpredictable variability can be solved by using the system dynamics simulation method due to its ability of representing very large and complex systems and defining dynamic uncertainties. Within the scope of this thesis, it is aimed to make analysis to reduce long waiting times of the patients by using the system dynamic simulation method in the emergency department of a hospital by improving the patient process flow which is from the time they enter the emergency department to the time they leave the emergency department.

In line with this goal, a unique simulation model has been created to improve the process flow of the emergency department. The proposed model was operated with actual data from the hospital. It was examined whether the model represents the real system with the verification and validation steps performed on certain performance criteria in the model. Based on the successful results of the output analysis, various scenarios have been produced with hospital resources (doctor, triage specialist, registration staff and bed count) to reduce the waiting times of the patients and optimize the patient process flow in the emergency department. The possible behaviors of the system under these alternative scenarios was described.

This model, which was developed to improve the whole process flow from end to end of the emergency department by using the system dynamics approach, is one of the rare studies in the literature and therefore it is expected that it will be used as an example in future studies in this field and will be developed and used for different parts of health services.