Abstract The Emergency Department (ED) management environment is complex and the highly variable demand for care in a given timeframe leads their managers to try to adjust their resources to meet the demand. Managers are usually forced to identify strategies and make decisions without effective knowledge of the actual state of processes or the impact of their decisions. However, the fact that (EDs) are run based on Medical Guidelines that define performance criteria targets contributing to delivering efficient management should be highlighted. Nonetheless, identifying improvement actions based on the criteria defined and making effective decisions is no easy task given the level of complexity of ED management environments. To this end, this paper introduces a Framework based on the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method with Discrete Event Simulation (DES) as support in devising improvement actions with a view to enhancing management performance for an ED that services patients covered by the Brazilian federal government’s single healthcare system (Sistema Unico de Saude - SUS). Deploying the DEMATEL method enabled identifying the influential and important criteria in the criteria network used to run the patient care and treatment process management and, in their turn, devising improvement actions for the ED under study. In addition, in many cases, process specialists are unaware of the concrete impacts resulting from the implementation of these actions. Therefore, the proposed Framework incorporates knowledge of the DES to test the improvement actions through simulated scenarios. This new approach (DEMATEL-DES Framework) can help establish a system for the decision-making process that, in its turn, can support ED managers in making complex decisions.

中文翻译：

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应急部门管理决策的支持框架

摘要 急诊科 (ED) 管理环境复杂，在给定时间范围内对护理的高度可变需求导致其管理人员试图调整其资源以满足需求。管理人员通常被迫确定战略并做出决策，而无需有效了解流程的实际状态或其决策的影响。然而，应该强调（ED）基于定义有助于提供有效管理的绩效标准目标的医疗指南运行的事实。尽管如此，鉴于 ED 管理环境的复杂程度，根据定义的标准确定改进措施并做出有效决策并非易事。为此，本文介绍了一个基于决策试验和评估实验室 (DEMATEL) 方法的框架，并以离散事件模拟 (DES) 作为支持设计改进行动，以期提高为巴西联邦涵盖的患者提供服务的 ED 的管理绩效。政府的单一医疗保健系统 (Sistema Unico de Saude - SUS)。部署 DEMATEL 方法能够在用于运行患者护理和治疗过程管理的标准网络中识别有影响力的重要标准，进而为所研究的 ED 制定改进措施。此外，在许多情况下，流程专家并不了解实施这些行动所产生的具体影响。 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 所以，提议的框架结合了 DES 的知识，通过模拟场景测试改进措施。这种新方法（DEMATEL-DES 框架）可以帮助建立一个决策过程系统，反过来，它可以支持 ED 管理人员做出复杂的决策。