Lean healthcare integrated with discrete event simulation and design of experiments: an emergency department expansion

Background. Discrete Event Simulation (DES) and Lean Healthcare are management tools that are efficient and assist in the quality and efficiency of health services. In this sense, the purpose of the study is to use lean principles jointly with DES to plan the expansion of a Canadian emergency department and to the demand that comes from small closed care centers. Methods. For this, we used simulation and modeling method. We simulated the emergency department in FlexSim Healthcare® software and, with the Design of Experiments (DoE), we defined the optimal number of locations and resources for each shift. Results. The results show that the ED cannot meet expected demand in the current state. Only 17.2% of the patients were completed treated, and the Length of Stay (LOS), on average, was 2213.7, with a confidence interval of (2131.8 - 2295.6) minutes. However, after changing decision variables, the number of treated patients increased to 95.7% (approximately 600%). Average LOS decreased to 461.2, with a confidence interval of (453.7 - 468.7) minutes, about 79.0%. In addition, the study shows that emergency department staff are balanced, according to Lean principles.