1. A Simulation Model for Bioterrorism Preparedness in An Emergency Room Lisa Patvivatsiri Department of Industrial Engineering Texas Tech University Presented by Hoang Bui Computer Science Department Midwestern State University

2. Overview Introduction Why uses simulation? Emergency room process Simulation model Experimental scenario analysis Question

3. Introduction Bioterrorism threats after 9/11/2001 Requirement for a quick response plan Lack of prior knowledge

4. Why uses simulation? Validity Real-time processing User interface Flexibility Easy to use

5. Emergency room process Medium size hospital in Lubbock, Texas Some definitions: ◦ Pod: a section in the ER  Pod A: 19 beds  Pod B: 12 beds  Pod C: 10 beds  19 additional beds in hall way Severe patients Serious injured patients Walking-wounded patients Charge nurses

6. Emergency room process

7. Arrival process Walk-In Patient ◦ 723 patients per week ◦ IAT = 13.94 minutes Ambulance ◦ 5 patients per day ◦ IAT = 288 minutes Helicopter ◦ 1 per week ◦ IAT = 10080 minutes

8. Triage and Pod assignment Walk-In patient: ◦ Go in to triage process  4 triage nurses  Service time: triangular distribution(20,23,25) ◦ Send to Pod A, B or C Ambulance and Helicopter patient: ◦ Send to Pod A

9. Treatment process Resource: ◦ Pod C: 11:00AM – 11:00 PM ◦ 6 treatment nurses per pod ◦ 3 shared medical doctors Bedside registration by a charge nurse Initial assessment by a treatment nurse MD evaluation ◦ 86 of 723 patients require further lab test

10. Treatment process

11. Simulation model

12. Software: ◦ Flexsim 2.6 ◦ Input and output spreadsheet in Excel 2003 Assumption: ◦ Testing equipment is not included ◦ Testing time is triangular distribution(95,156,192) ◦ Doctors and nurses in Pod C work overtime ◦ A patient releases his bed only when leaving

13. Simulation model Validation and Verification ◦ Meet frequently with E.R. director and staff ◦ Data collected by E.R. supervisor ◦ 7 days warm-up follow by 30 days run ◦ 10 replications ◦ Average time in system:202.42 minutes(simulation) vs. 207.42 minutes (actual)

14. Experimental scenario analysis Outbreak of contagious disease: ◦ 432 people are infected during 72 hours ◦ Addition patients every 10 minutes during 1 st 72 hours

15. Experimental scenario analysis

16. Proposed new strategy ◦ Move 10 beds from Pod A to Pod B, and 12 beds in the hallway to Pod C ◦ Move 2 treatment nurses from Pod A to Pod C ◦ Add 4 treatment nurses to Pod B ◦ Add 2 more MD

17. Experimental scenario analysis

20. Questions

21. Reference A Simulation Model for Bioterrorism Preparedness in An Emergency Room by Lisa Patvivatsiri, In Proceedings of the 2006 Winter Simulation Conference.