Safety assessment for temporary hospitals during the COVID-19 pandemic: A simulation approach.

Amid the devastating effects caused by the pandemic of the new Coronavirus (COVID-19), health leaders around the world are adding efforts to search efficient and effective responses in the fight against the disease. Conventional health centers, such as hospitals and emergency departments have been registering an increase in demand and atypical patterns due to the high transmissibility of the virus. In this context, the adoption of Temporary Hospitals (THs) is effective in trying to relieve conventional hospitals and direct efforts in the treatment of suspected and positive patients for COVID-19. However, some requirements should be considered regarding the processes performed by THs to maintain the health and safety of patients and staff. Based on the literature, we evaluated aspects related to patient safety in THs, especially linked to biosafety of medical facilities, and patient transport and visit. We highlight the analysis of flows and layouts, hospital cleaning and patient care. We described two case studies to demonstrate the proposed approach. As result, simulation tests improved safety metrics, such as waiting time for procedures, movement intensity in each area, length of stay and TH capacity. We conclude that the approach allows us to provide better THs that prevent cross-contamination, provide suitable care, and meet the demand.

Lean thinking by integrating with discrete event simulation and design of experiments: an emergency department expansion.

BACKGROUND: Many management tools, such as Discrete Event Simulation (DES) and Lean Healthcare, are efficient to support and assist health care quality. In this sense, the study aims at using Lean Thinking (LT) principles combined with DES to plan a Canadian emergency department (ED) expansion and at meeting the demand that comes from small care centers closed. The project's purpose is reducing the patients' Length of Stay (LOS) in the ED. Additionally, they must be assisted as soon as possible after the triage process. Furthermore, the study aims at determining the ideal number of beds in the Short Stay Unit (SSU). The patients must not wait more than 180 min to be transferred. METHODS: For this purpose, the hospital decision-makers have suggested planning the expansion, and it was carried out by the simulation and modeling method. The emergency department was simulated by the software FlexSim Healthcare®, and, with the Design of Experiments (DoE), the optimal number of beds, seats, and resources for each shift was determined. Data collection and modeling were executed based on historical data (patients' arrival) and from some databases that are in use by the hospital, from April 1st, 2017 to March 31st, 2018. The experiments were carried out by running 30 replicates for each scenario. RESULTS: The results show that the emergency department cannot meet expected demand in the initial planning scenario. Only 17.2% of the patients were completed treated, and LOS was 2213.7 (average), with a confidence interval of (2131.8-2295.6) min. However, after changing decision variables and applying LT techniques, the treated patients' number increased to 95.7% (approximately 600%). Average LOS decreased to 461.2, with a confidence interval of (453.7-468.7) min, about 79.0%. The time to be attended after the triage decrease from 404.3 min to 20.8 (19.8-21.8) min, around 95.0%, while the time to be transferred from bed to the SSU decreased by 60.0%. Moreover, the ED reduced human resources downtime, according to Lean Thinking principles.