Huang Xiaoyan, Zhou Shuai, Ma Xudong, Yang Zhitao, Xu Yuanyuan, Shen Xiaoxiao, Zhang Zengni, Ning Guang, Chen Erzhen, Li Na, Lu Yong
Department of Director's Office, Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Venous Thromboembolism Alliance, Shanghai, China.
Ann Transl Med. 2022 May;10(10):545. doi: 10.21037/atm-22-1944.
The coronavirus disease 2019 (COVID-19) has forced accelerated optimization of Emergency Department (ED) process, and simulation tools offer an alternative approach to strategic assessment and selection.
Field research and case analysis methods were used to obtain the treatment process and medical records information from the ED of a general hospital. Minitab was used for analysis of the measurement system, and Arena was applied for simulation modelling. We established a framework for the triage protocol of ordinary and quarantined patients, analysed bottlenecks in the treatment time of the hospital's ED, and proposed an optimised management strategy.
The computed tomography (CT) pre-scheduling strategy simulation results demonstrated that longer CT room preparation times for quarantined people before their arrival (T) resulted in reduced CT scan and waiting times for quarantined patients, but these times were longer for ordinary patients. The nucleic acid priority strategy simulation results demonstrated that when the average daily number of ordinary patients (λ) was relatively stable, the hospital could guide ordinary patients to perform nucleic acid testing first followed by CT testing. However, when λ fluctuated greatly, the hospital could appropriately reduce the proportion of preferential nucleic acid testing. Furthermore, when λ was overloaded, the nucleic acid priority strategy showed no advantages. The joint analysis results demonstrated that the optimal strategy selection was significantly affected by the severity of the epidemic. The nucleic acid detection sample size optimisation strategy demonstrated that optimizing the sample size of each batch according to the number of patients could effectively reduce the waiting times for nucleic acid testing (T).
Simulation tools are an alternative method for strategic evaluation and selection that do not require external factors.
2019年冠状病毒病（COVID-19）促使急诊科（ED）流程加速优化，而模拟工具为战略评估和选择提供了一种替代方法。
采用实地研究和案例分析方法，从一家综合医院的急诊科获取治疗流程和病历信息。使用Minitab进行测量系统分析，并应用Arena进行模拟建模。我们建立了普通患者和隔离患者分诊协议的框架，分析了医院急诊科治疗时间的瓶颈，并提出了优化管理策略。
计算机断层扫描（CT）预排程策略模拟结果表明，隔离人员到达前CT室准备时间（T）越长，隔离患者的CT扫描和等待时间越短，但普通患者的这些时间更长。核酸优先策略模拟结果表明，当普通患者日均数量（λ）相对稳定时，医院可引导普通患者先进行核酸检测再进行CT检测。然而，当λ波动较大时，医院可适当降低优先核酸检测的比例。此外，当λ过载时，核酸优先策略无优势。联合分析结果表明，最佳策略选择受疫情严重程度的显著影响。核酸检测样本量优化策略表明，根据患者数量优化每批样本量可有效减少核酸检测等待时间（T）。
模拟工具是一种无需外部因素的战略评估和选择的替代方法。
