Background Many management tools, such as Discrete Event Simulation (DES) and Lean Healthcare, are efficient to support and assist health care quality. In this sense, the study aims at using Lean Thinking (LT) principles combined with DES to plan a Canadian emergency department (ED) expansion and at meeting the demand that comes from small care centers closed. The project‘s purpose is reducing the patients’ Length of Stay (LOS) in the ED. Additionally, they must be assisted as soon as possible after the triage process. Furthermore, the study aims at determining the ideal number of beds in the Short Stay Unit (SSU). The patients must not wait more than 180 min to be transferred. Methods For this purpose, the hospital decision-makers have suggested planning the expansion, and it was carried out by the simulation and modeling method. The emergency department was simulated by the software FlexSim Healthcare®, and, with the Design of Experiments (DoE), the optimal number of beds, seats, and resources for each shift was determined. Data collection and modeling were executed based on historical data (patients’ arrival) and from some databases that are in use by the hospital, from April 1st, 2017 to March 31st, 2018. The experiments were carried out by running 30 replicates for each scenario. Results The results show that the emergency department cannot meet expected demand in the initial planning scenario. Only 17.2% of the patients were completed treated, and LOS was 2213.7 (average), with a confidence interval of (2131.8–2295.6) min. However, after changing decision variables and applying LT techniques, the treated patients’ number increased to 95.7% (approximately 600%). Average LOS decreased to 461.2, with a confidence interval of (453.7–468.7) min, about 79.0%. The time to be attended after the triage decrease from 404.3 min to 20.8 (19.8–21.8) min, around 95.0%, while the time to be transferred from bed to the SSU decreased by 60.0%. Moreover, the ED reduced human resources downtime, according to Lean Thinking principles.

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通过与离散事件模拟和实验设计相结合的精益思维：急诊科的扩展

背景 许多管理工具，例如离散事件模拟 (DES) 和精益医疗保健，可以有效地支持和协助医疗保健质量。从这个意义上说，该研究旨在利用精益思维 (LT) 原则与 DES 相结合来规划加拿大急诊室 (ED) 的扩张，并满足关闭的小型护理中心的需求。该项目的目的是减少患者在急诊室的住院时间 (LOS)。此外，在分诊过程后必须尽快为他们提供帮助。此外，该研究旨在确定短期住宿单元（SSU）的理想床位数量。患者转移的等待时间不得超过 180 分钟。方法为此，医院决策者提出扩建规划，并通过仿真建模的方法进行。通过软件 FlexSim Healthcare® 模拟急诊科，并通过实验设计 (DoE) 确定每个班次的最佳床位、座位和资源数量。数据收集和建模是根据2017年4月1日至2018年3月31日的历史数据（患者到达）和医院使用的一些数据库来执行的。实验通过针对每个场景运行30次重复来进行。结果结果表明，急诊科无法满足最初规划场景中的预期需求。只有 17.2% 的患者完成治疗，LOS 为 2213.7（平均），置信区间为（2131.8–2295.6）分钟。然而，在改变决策变量并应用 LT 技术后，接受治疗的患者数量增加到 95.7%（约 600%）。平均LOS下降至461.2，置信区间为（453.7-468.7）min，约为79.0%。分诊后的就诊时间从 404.3 分钟减少到 20.8 (19.8–21.8) 分钟，约 95.0%，而从床上转移到 SSU 的时间减少了 60.0%。此外，根据精益思维原则，ED 减少了人力资源停机时间。