simulation modeling at bjc healthcare

Simulation Modeling at

BJC HealthCare

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Anna Henkel

Transformation Support, Center for Clinical Excellence

afh2831@bjc.org

• History of simulation at BJC HealthCare

• Overview of simulation applications

• Case Studies

– Mobile Pharmacy

– Preventable Harm Interventions

– OR Bed Flow

Outline

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History of Simulation Modeling at BJC

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Mid-2009: Identified

simulation as a key opportunity for the system

2009 2010 2011 2012 2013

Early 2010: System-wide

in-house training

2014

Early 2014: In-house SIMUL8 training

Mid 2013: Re-emphasis on simulation modeling as a

valuable performance improvement tool

Early 2010: Begin using simulation

system-wide

Late-2009: Selection of SIMUL8 as

BJC’s modeling software

2014: Integration

into Black Belt curriculum

2013: Attempt #2 to build

internal capacity

2011: Attempt #1 to build

internal capacity

2014: Attempt #3 to build

internal capacity

Simulation Applications at BJC

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• Administration

• Care Coordination

• Emergency Department

• Food Services

• Nursing Units

• Operating Room

• Outpatient Medical Practices

• Pharmacy

• Planning, Design &

Construction

• Radiology

• Revenue Cycle

Simulation type: Staff utilization

Questions:

1. What is the effect of variation in patient utilization on prescription

turnaround time?

2. What is the effect of staff resources on prescription turnaround time?

3. What is the impact of batching deliveries on prescription turnaround time?

Case Study 1: Mobile Pharmacy

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Inputs (variables) Outputs Controls

• Patient utilization • Delivery batch size • Staffing models

• Prescription turn around time

• Resource utilization

• House-wide patient census

• Delivery time

Case Study 1: Mobile Pharmacy

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Future State (45% Patient Utilization)

Results/Decision/Recommendations:

• With increased patient utilization, resource need less than originally

estimated

– i.e. originally anticipated adding 4 scanning stations to overall Mobile Pharmacy

workflow; simulation model revealed that only 2 additional scanning stations

necessary

Project Benefits:

• Prospective understanding of impact of increased patient utilization

• Validation of resource requests/new hires prior to initiating process

Case Study 1: Mobile Pharmacy

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Simulation type: Staff utilization

Questions:

1. What is the impact of varying patient acuity and patient census on staff

capacity required for executing falls and pressure ulcer interventions?

Case Study 2: Preventable Harm Interventions

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Inputs (variables) Outputs Controls

• Frequency of interventions

• Patient length of stay • Patient census • Type of staff to

respond

• Staff utilization • Intervention time by

patient fall & pressure ulcer acuity level

• Bed capacity • % isolation patients • Distribution of falls

acuity • Distribution of

pressure ulcer acuity

Case Study 2: Preventable Harm Interventions

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Pressure Ulcer

Prevention

Fall Prevention

Case Study 2: Preventable Harm Interventions

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Case Study 2: Preventable Harm Interventions

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“Low” fall risk patients ( ~12 patients)

“Moderate” fall risk patients (~23 patients)

“High” fall risk patients (~15 patients)

Results/Decision/Recommendations:

• Over 12 hours of a 24-hour time period is spent on fall and pressure

ulcer interventions for the average patient census

Project Benefits:

• Limited role differentiation for fall & pressure ulcer interventions

between staff revealed processes that neglected human potential

• Importance of clarifying standard protocol: model revealed that

some low risk patients required more staff time because of unclear

intervention protocol

Case Study 2: Preventable Harm Interventions

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Simulation type: Bed flow

Questions:

1. What is optimal number of pre-op and post-op beds?

2. What is the impact of shared pre-op/post-op beds?

3. How does families waiting in the pre-op/post-op bay affect flow?

Case Study 3: Pre-Op and Post-Op Bed Utilization

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Inputs (variables) Outputs Controls

• Case mix • # Available pre-op &

post-op beds • Use of space

(shared/separate, families occupy room)

• Utilization by bed type (pre-op, post-op & shared)

• Number of ORs • ASA scores

Case Study 3: Pre-Op and Post-Op Bed Utilization

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Results/Decision/Recommendations:

• Recommended number of beds ranged from depending on bed use

scenario (shared/separate bed pool, case load, bed use)

Project Benefits:

• Families staying in pre-op room had limited impact on number of

beds required (requirement increased by 1 bed)

• Standard ratio of pre-op/post-op beds to ORs (4:1) did not hold for

every scenario

– Impacted by unique needs of the pediatric population

Case Study 3: Pre-Op and Post-Op Bed Utilization

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Thank you!

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Anna Henkel

Transformation Support

Center for Clinical Excellence

BJC HealthCare

afh2831@bjc.org