Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework

The objective of this study was to develop an agent based modeling (ABM) framework to simulate the behavior of patients who leave a public hospital emergency department (ED) without being seen (LWBS). In doing so, the study complements computer modeling and cellular automata (CA) techniques to simul...

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Main Authors: Milad Yousefi, Moslem Yousefi, F.S. Fogliatto, R.P.M. Ferreira, J.H. Kim
Format: Article
Language:English
Published: Associação Brasileira de Divulgação Científica 2018-01-01
Series:Brazilian Journal of Medical and Biological Research
Subjects:
Online Access:http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2018000300610&lng=en&tlng=en
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author Milad Yousefi
Moslem Yousefi
F.S. Fogliatto
R.P.M. Ferreira
J.H. Kim
author_facet Milad Yousefi
Moslem Yousefi
F.S. Fogliatto
R.P.M. Ferreira
J.H. Kim
author_sort Milad Yousefi
collection DOAJ
description The objective of this study was to develop an agent based modeling (ABM) framework to simulate the behavior of patients who leave a public hospital emergency department (ED) without being seen (LWBS). In doing so, the study complements computer modeling and cellular automata (CA) techniques to simulate the behavior of patients in an ED. After verifying and validating the model by comparing it with data from a real case study, the significance of four preventive policies including increasing number of triage nurses, fast-track treatment, increasing the waiting room capacity and reducing treatment time were investigated by utilizing ordinary least squares regression. After applying the preventing policies in ED, an average of 42.14% reduction in the number of patients who leave without being seen and 6.05% reduction in the average length of stay (LOS) of patients was reported. This study is the first to apply CA in an ED simulation. Comparing the average LOS before and after applying CA with actual times from emergency department information system showed an 11% improvement. The simulation results indicated that the most effective approach to reduce the rate of LWBS is applying fast-track treatment. The ABM approach represents a flexible tool that can be constructed to reflect any given environment. It is also a support system for decision-makers to assess the relative impact of control strategies.
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spelling doaj.art-3ca229125c3e4f0c90b30331b62df5382022-12-21T22:30:48ZengAssociação Brasileira de Divulgação CientíficaBrazilian Journal of Medical and Biological Research1414-431X2018-01-0151310.1590/1414-431x20176961S0100-879X2018000300610Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based frameworkMilad YousefiMoslem YousefiF.S. FogliattoR.P.M. FerreiraJ.H. KimThe objective of this study was to develop an agent based modeling (ABM) framework to simulate the behavior of patients who leave a public hospital emergency department (ED) without being seen (LWBS). In doing so, the study complements computer modeling and cellular automata (CA) techniques to simulate the behavior of patients in an ED. After verifying and validating the model by comparing it with data from a real case study, the significance of four preventive policies including increasing number of triage nurses, fast-track treatment, increasing the waiting room capacity and reducing treatment time were investigated by utilizing ordinary least squares regression. After applying the preventing policies in ED, an average of 42.14% reduction in the number of patients who leave without being seen and 6.05% reduction in the average length of stay (LOS) of patients was reported. This study is the first to apply CA in an ED simulation. Comparing the average LOS before and after applying CA with actual times from emergency department information system showed an 11% improvement. The simulation results indicated that the most effective approach to reduce the rate of LWBS is applying fast-track treatment. The ABM approach represents a flexible tool that can be constructed to reflect any given environment. It is also a support system for decision-makers to assess the relative impact of control strategies.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2018000300610&lng=en&tlng=enLWBSEmergency departmentAgent based simulationCellular automataHealthcare industry
spellingShingle Milad Yousefi
Moslem Yousefi
F.S. Fogliatto
R.P.M. Ferreira
J.H. Kim
Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework
Brazilian Journal of Medical and Biological Research
LWBS
Emergency department
Agent based simulation
Cellular automata
Healthcare industry
title Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework
title_full Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework
title_fullStr Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework
title_full_unstemmed Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework
title_short Simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician: a cellular automaton and agent-based framework
title_sort simulating the behavior of patients who leave a public hospital emergency department without being seen by a physician a cellular automaton and agent based framework
topic LWBS
Emergency department
Agent based simulation
Cellular automata
Healthcare industry
url http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2018000300610&lng=en&tlng=en
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