Outpatient Practice Tips Management Outpatient Practice Tips
Discrete Event Simulation Of Outpatient Flow In A...
Transcript of Discrete Event Simulation Of Outpatient Flow In A...
![Page 1: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/1.jpg)
Discrete Event Simulation Of
Outpatient Flow In A Phlebotomy
Clinic
INFORMS, 11/15/2016
Elizabeth Olin Ajaay Chandrasekaran
Amy Cohn Carolina Typaldos
![Page 2: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/2.jpg)
Agenda
• Background: UMCCC / Phlebotomy Department
• Approach: Discrete Event Simulation
• Analysis: What-if Scenarios
• Future Work
2
![Page 3: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/3.jpg)
BACKGROUND
3
![Page 4: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/4.jpg)
4
UMHS Comprehensive Cancer Center
• Home to 17 multidisciplinary and 10 specialty clinics, organized by cancer type
• In 2015, over 50% of outpatient visits in the UMCCC resulted in chemotherapy infusion treatments:
– 97,147 outpatient visits
– 58,419 infusion treatments
• High outpatient demand for infusion causes:
– Process congestion
– Increased patient waiting times
– Overworked staff
![Page 5: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/5.jpg)
UMHS Comprehensive Cancer Center
5
Patient
Arrives
Chemotherapy/
Infusion Clinic
Pharmacy
Drug
Preparation
Patient
Discharged Phlebotomy Labs Collected
Information Flow
Material Flow
Patient Flow
Lab Processing
• Patient visit to Cancer Center
– Often long, multi-step process
– Can take anywhere from 30 min to 8 hrs
– Requires multi department coordination
![Page 6: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/6.jpg)
Potential Delays at Infusion
6
Patient
Arrives
Chemotherapy/
Infusion Clinic
Pharmacy
Drug
Preparation
Patient
Discharged Phlebotomy Labs Collected
Information Flow
Material Flow
Patient Flow
Lab Processing
DELAY
DELAY
DELAY
• Patient is late
• No infusion chairs are available
• Infusion drugs are unavailable
![Page 7: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/7.jpg)
Potential Delays at Clinic
7
Patient
Arrives
Chemotherapy/
Infusion Clinic
Pharmacy
Drug
Preparation
Patient
Discharged Phlebotomy Labs Collected
Information Flow
Material Flow
Patient Flow
Lab Processing
DELAY
DELAY
DELAY
• Patient is late
• Clinicians are unavailable
• Patient blood draw results are not ready
![Page 8: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/8.jpg)
• Phlebotomist not available (check-in and/or draw)
• Chair not available
• Orders not ready
Potential Delays at Phlebotomy
8
Patient
Arrives
Chemotherapy/
Infusion Clinic
Pharmacy
Drug
Preparation
Patient
Discharged Phlebotomy Labs Collected
Information Flow
Material Flow
Patient Flow
Lab Processing
DELAY
DELAY
DELAY
DELAY
![Page 9: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/9.jpg)
Patient
Arrives
Chemotherapy/
Infusion Clinic
Pharmacy
Drug
Preparation
Patient
Discharged Phlebotomy Labs Collected
Information Flow
Material Flow
Patient Flow
Lab Processing
Problem Statement
DELAY DELAY
DELAY DELAY DELAY
9
Delays in phlebotomy can ripple through the system
DELAY
DELAY
DELAY
DELAY
![Page 10: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/10.jpg)
Our Goal
10
Improve Phlebotomy process efficiency
and reduce patient wait times
to reduce overarching system delays
![Page 11: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/11.jpg)
Patient
Arrives
Chemotherapy
/ Infusion Clinic
Pharmacy
Drug
Preparation
Patient
Discharg
ed
Phlebotomy Labs Collected
Lab
Processing
Phlebotomy
11
Phlebotomy
Patient
Arrives
Waiting
Area
Check-In
- Generally 2-3
Phlebotomists
Blood Draw
- Draws by port or
vein access
- Generally 5-6
Phlebotomists
Lab
Processing
Clinic
• Nearly all patients enter the system through phlebotomy
• Multi-step/ multi-wait process increased patient waits
• Blood drawn for labs needed:
– By provider before clinic appointment to assess patient
– By pharmacy to initiate drug preparation
![Page 12: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/12.jpg)
Phlebotomy
12
• Large Waiting Room
• 3 Check-In Stations
• 9 Blood Draw Chairs
![Page 13: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/13.jpg)
Phlebotomy
13
• Large Waiting Room
• 3 Check-In Stations
• 9 Blood Draw Chairs
![Page 14: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/14.jpg)
14
![Page 15: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/15.jpg)
APPROACH
15
![Page 16: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/16.jpg)
Discrete Event Simulation
16
• Computer Simulation Tool:
– Visualize and analyze current operations
– Test and measure the impact of different “what if" scenarios without having to carry them out
– Manipulate input parameters to observe effect on various metrics
![Page 17: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/17.jpg)
Discrete Event Simulation
17
• User-specified
number of
iterations • 1 iteration = 1
simulated
“day”
• Based on • MiChart data
• Collected
data
• Expert
opinion
• Hospital
regulations
• Summary
statistics
• Metrics for
patients and
phlebotomists • Wait times
• Utilizations
Read Parameters
Run
Simulation Generate
Results
![Page 18: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/18.jpg)
Simulation Design
• Developed in C++
• Three (3) main event types, each corresponding to an availability queue:
– Patient Available for Check-In
– Patient Available for Blood Draw
– Phlebotomist Available
• As events occur, they are either completed or added to one of the availability queues
• Event Queue
– Events are created and added to queue during simulation
– Events in the queue complete in order (priority queue)
– While there are still events in the queue, continue completing them
18
![Page 19: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/19.jpg)
Base Case
19
0
10
20
30
40
Pat
ien
t A
rriv
al R
ate
/ h
r.
Time of Day
Patient and Staff Volumes by Time of Day
Patient Arrival Rate
• Patient arrival distributions representing current uneven volumes
![Page 20: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/20.jpg)
Base Case
20
0123456
0
10
20
30
40
Nu
mb
er
of
Ph
leb
oto
mis
ts
wo
rkin
g
Pat
ien
t A
rriv
al R
ate
/ h
r.
Time of Day
Patient and Staff Volumes by Time of Day
Draw Phlebotomists
Check-In Phlebotomists
Patient Arrival Rate
• Patient arrival distributions representing current uneven volumes
• Staffing levels based on current schedule (tailored to accommodate varying patient volumes)
![Page 21: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/21.jpg)
Base Case
21
Mean Wait Time (m:ss)
Check-In Draw Total
Base
Case 2:52 8:21 11:14
0
1
2
3
4
5
6
0
5
10
15
20
25
30
35
40
Nu
mb
er
of
Ph
leb
oto
mis
ts
wo
rkin
g
Pat
ien
t A
rriv
al R
ate
/ h
r.
Time of Day
Service Times
Description Mean (Standard
Deviation)
Check-In 3.25 min (1.23 min)
Blood Draw 10 min (4 min)
![Page 22: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/22.jpg)
ANALYSIS
22
![Page 23: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/23.jpg)
What-if Analysis
• See system sensitivity to variations in input parameters
• Variable parameters:
– Patient arrival rates and volumes
– Staffing Decisions (Number of phlebotomists/ task allocation)
– Service Times
– Etc.
23
![Page 24: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/24.jpg)
What-if Analysis: Ideal Case
• Leveling system variability
24
Scenario
Mean Wait Time (m:ss)
Check-In Draw Total
Base Case 2:52 8:21 11:14
Level Patient Arrivals 2:47 6:18 8:03
![Page 25: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/25.jpg)
What-if Analysis: Ideal Case
• Leveling system variability
25
Scenario
Mean Wait Time (m:ss)
Check-In Draw Total
Base Case 2:52 8:21 11:14
Level Patient Arrivals 2:47 6:18 8:03
Level Arrivals & Adjust Staffing (20 arrivals/hr & 2 Check-in, 5 Draw all day) 1:18 1:28 2:47
![Page 26: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/26.jpg)
What-if Analysis: Patient Volume Increase
• UMCCC experiences consistent growth
– Can current capacity handle increase volume?
26
Scenario
Mean Wait Time (mm:ss)
Check-In Draw Total
Base Case 2:52 8:21 11:14
+10%
Patient Volume 4:40 16:45 21:25
+20%
Patient Volume 7:24 28:45 36:10
+30%
Patient Volume 12:44 40:40 53:29
0
10
20
30
40
50
60
70
80
6:00 9:00 12:00 15:00
To
tal W
ait
(m
in)
Hour of Day
Average Total Wait by Time of Day
BaseCase
+10%
+20%
+30%
![Page 27: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/27.jpg)
Scenario (Assume Increased Volume Base Case: +20% Patient Volume)
Mean Wait Time (h:mm:ss)
Check-In Draw Total
No additional
Phlebotomist
Increased Volume Base Case:
+20% Patient Volume 7:24 28:45 36:10
- 1 Check-in Phlebotomist
+1 Draw Phlebotomist 1:47:15 5:32 1:42:43
1 Additional
Phlebotomist
+1 Draw Phlebotomist 7:32 6:29 14:01
+1 Check-in Phlebotomist 0:59 32:54 33:53
2 Additional
Phlebotomists
+1 Draw Phlebotomist
+1 Check-in Phlebotomist 0:58 10:35 11:34
What-if Analysis: Patient Volume Increase
• UMCCC experiences consistent growth
– Could staffing changes help accommodate?
27
![Page 28: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/28.jpg)
Conclusions
• Cancer Center patient visits can be long, multi-step processes
• Expected growth and bottlenecks in the current system necessitate process improvements
• Simulation techniques allow ‘what-if ’ analysis for improvements without impacting current system
• Results can
– Highlight issues
– Explore areas of potential improvement
– Support decisions for change implementation
28
![Page 29: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/29.jpg)
Future Work
29
• Better representing reality (current state) with more accurate:
– Service time distributions
– Arrival rate data
– Non-instantaneous service transitions
– Phlebotomist roles
• Exploration of additional “what-if” scenarios
• Pilot study for implementation of improvements
• Additional applications (outside of Phlebotomy) of simulation design
![Page 30: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/30.jpg)
Acknowledgements
• Center for Healthcare Engineering and Patient Safety (CHEPS)
• Seth Bonder Foundation
• UMHS Comprehensive Cancer Center
• Research Collaborators
– CHEPS students and staff
– Cancer Center clinical collaborators and representatives (especially those from the Phlebotomy Department)
30
![Page 31: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/31.jpg)
QUESTIONS?
Thank you!
31
CONTACT INFORMATION:
Elizabeth Olin – [email protected]
Amy Cohn – [email protected]
![Page 32: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/32.jpg)
32
Appendix
Service Times
Description Mean (Standard Deviation)
Check-In 3.25 min (1.23 min)
Blood Draw 10 min (4 min)
- 2015 PHLEBOTOMY TIME STUDIES
![Page 33: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/33.jpg)
Simulation Design
33
Event Type Participant ID Time
PatientAvailCI 3948 7:03:42
PatientAvailCI 2084 7:06:12
PhlebAvail 0962 7:15:00
PatientAvailCI 5541 7:16:09
PatientAvailCI 8737 7:20:33
Event Queue
Participant ID Time
PatientAvailCI
Queue Participant ID Time
PhlebAvail
Queue
Clock
![Page 34: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/34.jpg)
Simulation Design
34
Event Type Participant ID Time
PatientAvailCI 3948 7:03:42
PatientAvailCI 2084 7:06:12
PhlebAvail 0962 7:15:00
PatientAvailCI 5541 7:16:09
PatientAvailCI 8737 7:20:33
Event Queue
Participant ID Time
PatientAvailCI
Queue Participant ID Time
PhlebAvail
Queue
Clock
![Page 35: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/35.jpg)
Simulation Design
35
Event Type Participant ID Time
PatientAvailCI 2084 7:06:12
PhlebAvail 0962 7:15:00
PatientAvailCI 5541 7:16:09
PatientAvailCI 8737 7:20:33
Event Queue
Participant ID Time
3948 7:03:42
PatientAvailCI
Queue Participant ID Time
PhlebAvail
Queue
Clock
![Page 36: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/36.jpg)
Simulation Design
36
Event Type Participant ID Time
PatientAvailCI 2084 7:06:12
PhlebAvail 0962 7:15:00
PatientAvailCI 5541 7:16:09
PatientAvailCI 8737 7:20:33
Event Queue
Participant ID Time
3948 7:03:42
PatientAvailCI
Queue Participant ID Time
PhlebAvail
Queue
Clock
![Page 37: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/37.jpg)
Simulation Design
37
Event Type Participant ID Time
PhlebAvail 0962 7:15:00
PatientAvailCI 5541 7:16:09
PatientAvailCI 8737 7:20:33
Event Queue
Participant ID Time
3948 7:03:42
2084 7:06:12
PatientAvailCI
Queue Participant ID Time
PhlebAvail
Queue
Clock
![Page 38: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/38.jpg)
Simulation Design
38
Event Type Participant ID Time
PhlebAvail 0962 7:15:00
PatientAvailCI 5541 7:16:09
PatientAvailCI 8737 7:20:33
Event Queue
Participant ID Time
3948 7:03:42
2084 7:06:12
PatientAvailCI
Queue Participant ID Time
PhlebAvail
Queue
Clock
![Page 39: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/39.jpg)
Simulation Design
39
Event Type Participant ID Time
PhlebAvail 0962 7:15:00
PatientAvailCI 5541 7:16:09
PatientAvailCI 8737 7:20:33
Event Queue
Participant ID Time
3948 7:03:42
2084 7:06:12
PatientAvailCI
Queue Participant ID Time
PhlebAvail
Queue
Generate Service Time:
2 minutes 51 seconds
Clock
![Page 40: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/40.jpg)
Simulation Design
40
Event Type Participant ID Time
PatientAvailCI 5541 7:16:09
PatientAvailCI 8737 7:20:33
PatientAvailBD 3948 7:17:51
PhlebAvail 0962 7:17:51
Event Queue
Participant ID Time
2084 7:06:12
PatientAvailCI
Queue Participant ID Time
PhlebAvail
Queue
Clock
![Page 41: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/41.jpg)
Appendix
• Phlebotomy – 253 patients per day
• Clinic (7 Total) – 311 patients per day
• Infusion – 123 patients per day
– 20% of infusion appointments are coupled
41
![Page 42: Discrete Event Simulation Of Outpatient Flow In A ...cheps.engin.umich.edu/wp-content/uploads/sites/118/... · 4 UMHS Comprehensive Cancer Center • Home to 17 multidisciplinary](https://reader031.fdocuments.in/reader031/viewer/2022041118/5f2dae6b7770b87a26316cc0/html5/thumbnails/42.jpg)
Appendix
42
• Staff Schedule