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Using Discrete Event Simulation to Improve Diagnostic Imaging Resource Utilization

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

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  1. Using Discrete Event Simulation to Improve Diagnostic Imaging Resource Utilization Pheba Philip Ashley Robinson June 2014

  2. Outline • MD Anderson & the Breast Diagnostic Center • Problem & Aim Statement • Simulation Preparation • Building the Simulation • Initial Results • Next Steps • Challenges

  3. 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

  4. 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

  5. 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

  6. 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.

  7. SIMULATION PREPARATION

  8. 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

  9. 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

  10. Simulation Preparation • Four Patient Flow Charts • Diagnostic Mammo • Ultrasound • Diagnostic to Mammo • Stereotactic

  11. Simulation Preparation Process Flow

  12. Simulation Preparation

  13. Simulation Preparation Data Collection • Activities captured for • Electronic Data Validation • Simulation

  14. Simulation Preparation Data Collection Baseline 63.4 (min) 42% 34% 24%

  15. Simulation Preparation Data Collection

  16. BUILDING THE SIMULATION

  17. Building the Simulation

  18. Building the Simulation Insert the schedule of all labor resources represented in the model

  19. Building the Simulation Diagnostic Mammo Ultrasound Wait Area Patient Path Diagnostic Mammo Entrance & Exit Radiologist Reading Room

  20. Building the Simulation

  21. Building the Simulation

  22. Initial Results

  23. Next Steps • Validate simulation results • Recommend changes based on simulation output • Create new simulation with recommended changes

  24. 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

  25. Supplementary MD Anderson Volume of Clinical Activity2

  26. Supplementary

  27. Supplementary

  28. 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

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