Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
BMC Med Inform Decis Mak. 2024 Oct 9;24(1):295. doi: 10.1186/s12911-024-02704-y.
Overcrowding and extended waiting times in emergency departments are a pervasive issue, leading to patient dissatisfaction. This study aims to compare the efficacy of two process mining and simulation models in identifying bottlenecks and optimizing patient flow in the emergency department of Al-Zahra Hospital in Isfahan. The ultimate goal is to reduce patient waiting times and alleviate population density, ultimately enhancing the overall patient experience.
This study employed a descriptive, applied, cross-sectional, and retrospective design. The study population consisted of 39,264 individuals referred to Al-Zahra Hospital, with a sample size of at least 1,275 participants, selected using systematic random sampling at a confidence level of 99%. Data were collected through a questionnaire and the Hospital Information System (HIS). Statistical analysis was conducted using Excel software, with a focus on time-averaged data. Two methods of simulation and process mining were utilized to analyze the data. First, the model was run 1000 times using ARENA software, with simulation techniques. In the second step, the emergency process model was discovered using process mining techniques through Access software, and statistical analysis was performed on the event log. The relationships between the data were identified, and the discovered model was analyzed using the Fuzzy Miner algorithm and Disco tool. Finally, the results of the two models were compared, and proposed scenarios to reduce patient waiting times were examined using simulation techniques.
The analysis of the current emergency process at Al-Zahra Hospital revealed that the major bottlenecks in the process are related to waiting times, inefficient implementation of doctor's orders, delays in recording patient test results, and congestion at the discharge station. Notably, the process mining exercise corroborated the findings from the simulation, providing a comprehensive understanding of the inefficiencies in the emergency process. Next, 34 potential solutions were proposed to reduce waiting times and alleviate these bottlenecks. These solutions were simulated using Arena software, allowing for a comprehensive evaluation of their effectiveness. The results were then compared to identify the most promising strategies for improving the emergency process.
In conclusion, the results of this research demonstrate the effectiveness of using simulation techniques and process mining in making informed, data-driven decisions that align with available resources and conditions. By leveraging these tools, unnecessary waste and additional expenses can be significantly reduced. The comparative analysis of the 34 proposed scenarios revealed that two solutions stood out as the most effective in improving the emergency process. Scenario 19, which involves dedicating two personnel to jointly referring patients to the ward, and scenario 34, which creates a dedicated discharge hall, have the potential to create a more favorable situation.
急诊部门的过度拥挤和延长的等待时间是一个普遍存在的问题，导致患者不满意。本研究旨在比较两种流程挖掘和模拟模型在识别瓶颈和优化伊斯法罕 Al-Zahra 医院急诊部门患者流程方面的功效。最终目标是减少患者等待时间和缓解人口密度，从而提高整体患者体验。
本研究采用描述性、应用、横断面和回顾性设计。研究人群由 39264 名被转诊至 Al-Zahra 医院的个体组成，样本量至少为 1275 名，采用系统随机抽样，置信水平为 99%。数据通过问卷和医院信息系统（HIS）收集。使用 Excel 软件进行统计分析，重点关注时间平均数据。使用 Arena 软件进行模拟技术的 1000 次模型运行，使用过程挖掘技术通过 Access 软件发现急诊流程模型，并对事件日志进行统计分析。识别数据之间的关系，并使用 Fuzzy Miner 算法和 Disco 工具分析发现的模型。最后，比较两种模型的结果，并使用模拟技术检查减少患者等待时间的建议方案。
对 Al-Zahra 医院当前急诊流程的分析表明，该流程中的主要瓶颈与等待时间、医生医嘱执行效率低下、患者检查结果记录延迟以及出院站拥堵有关。值得注意的是，流程挖掘工作与模拟结果相吻合，全面了解了急诊流程中的效率低下问题。接下来，提出了 34 项潜在的解决方案，以减少等待时间并缓解这些瓶颈。使用 Arena 软件对这些解决方案进行模拟，全面评估其效果。然后将结果进行比较，以确定改善急诊流程的最有效策略。
总之，本研究结果表明，使用模拟技术和流程挖掘来做出明智的数据驱动决策是有效的，这些决策符合可用资源和条件。通过利用这些工具，可以显著减少不必要的浪费和额外的费用。对 34 个建议方案的比较分析表明，有两个方案在改善急诊流程方面最为有效。方案 19，即指定两名人员共同将患者转诊至病房，以及方案 34，即创建一个专门的出院大厅，有可能创造更有利的局面。
