ER staffing Model when the staff have to be reassign for Trauma patients

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Atipol Kanchanapiboon asked Jan 17, '18 Atipol Kanchanapiboon commented Feb 16, '18

ER staffing Model when the staff have to be reassign for Trauma patients

This question is related to my earlier question about Model with staffing ratios to the patients here . I used @Cliff King sample model from here and modify into my staffing model for the ER. Here is how it works:

There are 5 patient severity level (PCI 1 with the highest severity and PCI 5 with the lowest acuity) arriving to the ER.
Severity 1, 2, and 3 will be assigned to Main ED Beds serving by 2 Main ED RNs. The staffing ratio is 4:1 (except severity 1 that will need help to modify this model). Therefore, I defined the workload for PCI 1/2/3 at 25 (out of max workload of 100%) for each patient.
Severity 4, 5 will be assigned to Fast Track beds serving by 2 Fast Track RNs. The staffing ratio is 6:1. Therefore, I defined the workload for PCI 4/5 at 16.6 (out of max workload of 100%) for each patient.
Bed Assignment will not be done if all RNs in that designated area reach the full staffing ratios (for example both RNs in Main ED already reach 4 patients each)

I can get the model running fine, except there is a need to update this model for PCI 1 which is the sickest (trauma) patient. This patient will always be assign to a bed and an RN as they arrived. They will never wait in the waiting room even if all RNs in the Main EDs are at full workload. What needs to happen is patient will be placed in the main ED and one of the RN with the lowest workload will be assigned to this PCI 1 patient immediately at the staffing ratio of 1:1. Therefore, that will be the only patient on that nurse workload. All of her previous assignments will be redistributed to The remaining RNs with the lowest workload even if doing that will bring each of their staffing ratio over the cap of 4:1.

Can you please help how should I update my model for this? Thank you in advance.

Software Version:

FlexSim HC 5.3.4

staff assignment emergency room staffing ratio

er-staffing-model-v3-2mained-rns.fsm (202.6 KiB)

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Attachments: Up to 12 attachments (including images) can be used with a maximum of 23.8 MiB each and 47.7 MiB total.

Cliff King commented · Jan 24, 2018 at 12:13 AM

Sorry for the delay in getting back to you. I've been away on vacation and just got back. I will hopefully have some time to look into this either tomorrow or the next day... I may contact you to get with me on a web meeting if I have questions!

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Atipol Kanchanapiboon Cliff King commented · Jan 26, 2018 at 02:53 PM

Thanks in advance for looking into this for us @Cliff King

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Cliff King Atipol Kanchanapiboon commented · Jan 26, 2018 at 05:13 PM

OK, I've had a chance to carefully read your description and am now looking at the model. Nice job of setting up the scenario for me in a simple model, thanks! Let me play with some different ideas and see what I can come up with...

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Answer 1 · 2018-01-29T19:18:24Z

Cliff King answered Jan 29, '18 Atipol Kanchanapiboon commented Feb 16, '18

Atipol,

Is the suggested solution I outlined with the "Patient Assigned Based on Nurse Workload With Special Trauma Case.fsm" model going to work for you? A full solution is going to be very complex, so I didn't want to continue until I hear back from you

Cliff

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5 |100000

Attachments: Up to 12 attachments (including images) can be used with a maximum of 23.8 MiB each and 47.7 MiB total.

Atipol Kanchanapiboon commented · Jan 29, 2018 at 07:26 PM

Hi @Cliff King

Thanks for looking into this for us. Sorry that I won't have to get a chance to get this this until tomorrow morning. Let's hold on to your complex version for now. I will play with the model and get back to you tomorrow or Wednesday. Appreciate your help.

Atipol

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Atipol Kanchanapiboon commented · Jan 31, 2018 at 07:43 PM

@Cliff King,

I just had a chance to review your model. It looks good, exactly what needs to happen when PCI 1 arrived. It is really interesting that small modification allows the model to handle this.

It maybe useful if I share the additional information about the more detailed version model with you before you start going into more complex work:

-Trauma patient arrival are not normal. Approximately only 1% of the patients are trauma. I know there will be issues if there are multiple patients arriving at the same time and you cannot reassign the existing patient to any other nurses since everyone got these trauma patients. The special cases like a big car accident with multiple trauma patients arriving to ER will not be considered since we try to model 'regular days' for the ER. I think we can assume that is no multiple trauma patients arriving for this first cut.

-The LOS in step 50 is a bit inflated from actual LOS for ER. Normally PCI 1/2/3 LOS should be around 180-360 minutes and PCI 4/5 should be around 90-150 minutes.

-Actually, the workload of 100 (1:1) for the PCI 1 will be only for maximum certain amount of time (e.g. 60-90 minutes) after patient arrives to stabilize the trauma condition. Before this time is over, some patients may be sent to OR or expired (both consider depart from the system). If they stay longer than this time, the workload will be reduced regular critical care workload of 50 (2:1). If this is too complex to do it for this first cut, we can skip this for now.

-The goal of the model is to evaluate the sensitivity of the staffing level to length of stay. For example, if you add more nurses, they will be less patient wait in the waiting room. If you reduce nurses, they will be more patients in the waiting rooms. We just want to find the optimal point for staffing level by time of the day and acceptable wait time. If you feel there is a better way to model this, I am open to the change as well.

-Accuracy of the animation in the model is not very important. We can simply remove step 61 and 62 on patient track or assume any nurse can do it.

Hope this helps. Thanks again for your support for this.

Atipol

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Atipol Kanchanapiboon commented · Feb 16, 2018 at 07:06 PM

@Cliff King, just a friendly follow up for this model. Do you need more information for this? Please kindly let us know. Thanks.

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Cliff King Atipol Kanchanapiboon commented · Feb 16, 2018 at 07:47 PM

Thanks for the follow up. I wasn't sure how to proceed on this question. I think it might be a good idea if you create a new sample model that ignores the nurse/patient ratio requirement for now, but includes all the other aspects you need the model to capture. such as the appropriate LOS for each PCI, a stabilize activity for PCI 1 and decision points for removing some PCI patients from the model early as you explained above. When PCI 1 (trauma) patients arrive in the model, the stabilize activity can preempt nurses from their normal duties automatically if the stabilize activity has a priority of 200 or higher.

Try building an updated sample model and taking it as far as you can without my help, and then let me know where you get stuck.

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Atipol Kanchanapiboon Cliff King commented · Feb 16, 2018 at 07:50 PM

Thanks for your advice, Cliff. Let me work on this and reach out to you later.

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