Document Type : Original Article
Authors
1 MSc, Industrial Engineering, New Business Department, Faculty of Entrepreneurship, University of Tehran, Tehran, Iran
2 Associate Professor, Industrial Engineering, New Business Department, Faculty of Entrepreneurship, University of Tehran, Tehran, Iran
3 Assistant Professor, Industrial Engineering, Department of Industrial Engineering, KHATAM University, Tehran, Iran
Abstract
Introduction: One of the major indicators for evaluating the quality of services in medical centers is the waiting time for patients. If the treatment process is prolonged, it can give rise the patients to leave the system before the end of the treatment process and with personal consent. The purpose of this research was to evaluate the service process of a treatment center and improve the treatment process through discrete-event simulation to reduce patient waiting time and reduce the number of patients with discharging by personal satisfaction despite the doctor's advice (DAMA: Discharged against Medical Advice).Methods: This was a descriptive study involving patients referred to Khatam Al-Anbia hospital in Tehran, Iran, in the fall of 2018. Data collection tools were as questionnaires, and face-to-face and telephone interviews with experts and researchers. Content for data collection formats included the patient's arrival time, and the start and end time of receiving services in various departments and units. In the next step, the data were modeled, different scenarios were analyzed, and the best scenario was selected from them.Results: In the seven proposed studied scenarios, the seventh scenario, which was a combination of the other six proposed scenarios, improved the treatment system. In this scenario, it was observed that the cost of value added with a slight increase from 399807373 in the initial model to 401561100 in the seventh scenario, with a significant decrease in the waiting cost from 2494256 currency units in the initial model to 16472202 currency units in the seventh scenario. Other proposed scenarios were more effective in reducing the total cost, from 649228933 monetary units in the initial model to 418033302 monetary units in the seventh scenario, which ultimately led to proper classification of workflow and improvement of performance indicators studied.Conclusion: The results reveal that by changing the resources and beds allocated to patients (optimal amount), it is possible to provide better services to patients, eliminate their dissatisfaction, and reduce the number of DAMA patients, waiting time of patients, and the losses in the service process.
Keywords
- Maleki A, Sajadi SM, Rezaee Khaboushan B. Explanation and improvement performance indicators of the emergency system using discrete event simulation (Case study: Arak Imam Khomeini Hospital). Health Inf Manage 2014; 11(1): 16. [In Persian].
- Kirsch TD. Emergency medicine around the world. Ann Emerg Med 1998; 32(2): 237-8.
- Weiss SJ, Derlet R, Arndahl J, Ernst AA, Richards J, Fernandez-Frackelton M, et al. Estimating the degree of emergency department overcrowding in academic medical centers: Results of the National ED Overcrowding Study (NEDOCS). Acad Emerg Med 2004; 11(1): 38-50.
- Dehghan Nayeri N, Ghofrani F, Ajez HR. Factors affecting the length of patients’ stay in emergency units of hospitals affiliated to Tehran University of Medical Sciences from the viewpoint of emergency nurses. Advances in Nursing and Midwifery 2016; 25(91): 57-65. [In Persian].
- Tabibi SJ, Najafi B, Shoaie S. Waiting time in the emergency department in selected hospitals of Iran University of Medical Sciences in 2007. Research in Medicine 2009; 33(2): 117-22. [In Persian].
- Henry B, Dunbar T, Barclay L, Thompson R. Self-discharge against medical advice from northern territory hospitals. Darwin, Australia: Charles Darwin University; 2007.
- Rangraz Jedi F, Rangraz Jedi M, Rezaeimofrad MR. Patients’ reasons for discharge against medical advice in university hospitals of Kashan University of Medical Sciences in 2008. Hakim Res J 2010; 13(1): 33-9. [In Persian].
- Estebsari F, Dastoorpoor M, Mosavi Esfahani H, Mostafaie D. The causes of discharge against medical advice from the emergency department of a teaching hospital of Tehran in 2012. Health Develop J 2016; 5(3): 267-76. [In Persian].
- Meigounpoory MR, Sajadi SM, Danehzan I. Conceptualization of the factors affecting the quality of mobile health services of active SMEs in healthcare system. International Journal of Management, Accounting and Economics 2014; 1(4): 311-21.
- Al-Refaie A, Fouad RH, Li MH, Shurrab M. Applying simulation and DEA to improve performance of emergency department in a Jordanian hospital. Simul Model Pract Theory 2014; 41: 59-72.
- Chan TC, Killeen JP, Kelly D, Guss DA. Impact of rapid entry and accelerated care at triage on reducing emergency department patient wait times, lengths of stay, and rate of left without being seen. Ann Emerg Med 2005; 46(6): 491-7.
- Zare Mehrjardi Y, Hoboubati M, Safaee Nik F. Improvement of waiting time for patients referring to emergency room using discrete event simulation. J Shahid Sadoughi Univ Med Sci 2011; 19(3): 302-12. [In Persian].
- Sepehri Z, Arabzad SM, Sajadi S. Analysing the performance of emergency department by simulation: The case of Sirjan Hospital. Int J Serv Oper Manag 2015; 20(3): 289-301.
- Sajadi S, Ghasemi S, Vahdani H. Simulation optimisation for nurse scheduling in a hospital emergency department (Case study: Shahid Beheshti Hospital). Int J Ind Syst Eng 2016; 23(4): 405-19.
- Sepehri MM, Maleki M, Majlesi Nasab N. Designing a redeployment model for located ambulances. International Journal of Industrial Engineering and Production Management 2013; 24(2): 172-82. [In Persian].
- Mahabadi A, Ketabi S, Sajadi SM. Investigate the parameters which affect the patients waiting time in emergency department of orthopedic services in Ayatollah Kashani Hospital with the lean management approach. Health Inf Manage 2015; 11(7): 1016-25. [In Persian].
)