Desautels Faculty of Management, McGill University, Montreal, QC, Canada.
Simul Healthc. 2012 Feb;7(1):40-7. doi: 10.1097/SIH.0b013e3182301005.
Patient flow computer simulations allow Emergency Department stakeholders to assess operational interventions, develop utilization and performance measures, and produce estimates for budgeting or planning purposes. Key challenges of traditional discrete-event computer simulation software are their inherent complexity for modeling, coding, or analyzing output and their significant costs and training. We propose a simulation platform that runs in spreadsheets. Because of their low cost, popularity and powerful functionality and performance, spreadsheets also allow for the development and management of simulations that efficiently output results that are just as reliable as those from traditional software.
A spreadsheet simulation is developed by modeling one row as one simulated minute (more than 20,000 rows for a 2-week period). Uncertainty in arrivals, patient type, routing, and treatment times is modeled using the "rand()" function to simulate the state of the Emergency Department at a given point in time. The patient is tracked with embedded "if()" functions and summary statistics are obtained through range functions. We use an equivalence test to determine whether the resulting average length-of-stay figures are the same as those of a traditional simulation platform.
We find little significant difference in average length-of-stay figures between both models.
Spreadsheet simulations are as effective as traditional simulations but easier to use, understand, and implement. Spreadsheet software is widely available, at a fraction of the cost of discrete-event simulation software. Coding spreadsheet simulations may be more challenging as it requires a different and more novel expertise than traditional computer programming. However, spreadsheets can be organized to reference existing datasets, thus minimizing the burden of copying and likelihood of transcription errors and information leakage. Output analysis can also be customized with user-specific performance statistics and charts.
患者流量计算机模拟允许急诊部门利益相关者评估运营干预措施，制定利用和绩效指标，并为预算或规划目的生成估算。传统离散事件计算机模拟软件的主要挑战在于其建模、编码或分析输出的固有复杂性，以及其高昂的成本和培训要求。我们提出了一种在电子表格中运行的模拟平台。由于电子表格成本低、普及度高、功能强大且性能优异，因此也可用于开发和管理模拟，从而高效输出结果，这些结果与传统软件一样可靠。
通过将一行建模为一个模拟分钟（对于两周的时间段，超过 20,000 行）来开发电子表格模拟。使用“rand()”函数来模拟不确定性的到达时间、患者类型、路由和治疗时间，以模拟给定时间点的急诊部门状态。使用嵌入式“if()”函数跟踪患者，通过范围函数获得汇总统计信息。我们使用等效检验来确定生成的平均住院时间数字是否与传统模拟平台的数字相同。
我们发现两种模型的平均住院时间数字几乎没有显著差异。
电子表格模拟与传统模拟一样有效，但更易于使用、理解和实施。电子表格软件广泛可用，成本仅是离散事件模拟软件的一小部分。由于需要与传统计算机编程不同且更具创新性的专业知识，因此编写电子表格模拟可能更具挑战性。但是，可以组织电子表格以引用现有数据集，从而最大程度地减少复制的负担以及转录错误和信息泄露的可能性。还可以使用用户特定的性能统计信息和图表自定义输出分析。
