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Using Discrete Event Simulation to Improve Diagnostic Imaging Resource Utilization. Pheba Philip Ashley Robinson June 2014. Outline. MD Anderson & the Breast Diagnostic Center Problem & Aim Statement Simulation Preparation Building the Simulation Initial Results Next Steps Challenges.
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Using Discrete Event Simulation to Improve Diagnostic Imaging Resource Utilization Pheba Philip Ashley Robinson June 2014
Outline • MD Anderson & the Breast Diagnostic Center • Problem & Aim Statement • Simulation Preparation • Building the Simulation • Initial Results • Next Steps • Challenges
Background on MD Anderson • Located in Houston, TX • Found in 1941 • 20,000 Employees (1,600 faculty) • 650 inpatient beds • 1.3 M outpatient visits • Provided care to 120,000 patients in 2013 • Ranked Number 1 in cancer care by U.S. News and World Report
Background Breast Diagnostic Imaging • Sub-specialty of the Department of Diagnostic Radiology • Biopsies performed and Images taken of the breast to identify cancer • Over 54,000 procedure performed
Why use Simulation? • Understanding of complex systems • Identification of constraints in the system (patient flow, staff utilization, resource management) • Testing & experimentation • Visual tool to enhance communication • FlexSim Healthcare used for the simulation model
Problem & Aim Statement • Patients are experiencing long wait times and resources are under utilized in the breast diagnostic center. • The aim is to build a simulation model that identifies opportunities to reduce patient wait time and better utilize resources by April 2014.
Simulation Preparation Identify the Scope Wait time of patients with appointments in Mammo and US Utilization of labor and equipment Scheduling of patients, radiologist, and techs
Simulation Preparation • Center Information • Two Modalities: Diagnostic Mammo & Ultrasound (US) • 9 US Techs / 9 Mammo Techs • 3 US Radiologist / 2 Diagnostic Mammo Radiologist • 2 Diagnostic Assistants • 3 RNs • 8 Breast US Rooms/ 8 Diagnostic Mammo Rooms
Simulation Preparation • Four Patient Flow Charts • Diagnostic Mammo • Ultrasound • Diagnostic to Mammo • Stereotactic
Simulation Preparation Process Flow
Simulation Preparation Data Collection • Activities captured for • Electronic Data Validation • Simulation
Simulation Preparation Data Collection Baseline 63.4 (min) 42% 34% 24%
Simulation Preparation Data Collection
Building the Simulation Insert the schedule of all labor resources represented in the model
Building the Simulation Diagnostic Mammo Ultrasound Wait Area Patient Path Diagnostic Mammo Entrance & Exit Radiologist Reading Room
Next Steps • Validate simulation results • Recommend changes based on simulation output • Create new simulation with recommended changes
Before you begin… • What are you simulating? • Are you simulating something you can’t change? • Are you attempting to simulate EVERYTHING? EEK! • Validate, Validate, VALIDATE
Supplementary MD Anderson Volume of Clinical Activity2
Key Stats LOS Average Wait Times Volumes Operating Hours (closing time) Evaluation Modality concerns Bottlenecks? Space Sufficient? Utilization What-If Scenarios Supplementary Projected Demand DI Processes & Service Times Simulation Model Facility Layout