Modeling a Public Hospital Outpatient Clinic in Peru using Discrete Simulation

Valeria Quevedo, Javier Chapilliquen

Abstract

Having insurance or not makes a difference in terms of the procedure patients need to follow to be attended in public hospitals in Peru. Studies show a high dissatisfaction towards the service offered by public hospitals, mainly due to long waiting times, specially for patients with insurance. The initiatives implemented by the government to solve these problems were not supplemented with a rigorous analysis to help quantify their impact. The main objective of this study is to assess the quality of care at one of the most visited public hospitals in Peru. Discrete simulation was used to build a model which was validated through historical data and hospital personnel. The model is capable of measuring the service level and it facilitates the identification of bottlenecks. It identified the most critical medical specialties most utilized and that have the longest queues. The results also serve to identify the services with a low utilization rate. High idle time during the insurance verification process was identified as a problem. It seems insurance verification could be integrated with admission tasks or during other services. The model can be applied to any public hospital in Peru given the fact that their outpatients processes are similar.

References

  1. Abo-hamad W., Arisha A., 2013. Simulation-based framework to improve patient experience in an emergency department. European Journal of Operations Research. Vol. 224. Pp 154-166.
  2. Al-Araidah O., Boran A., Wahsheh A., 2012. Reducing Health Care Delivery at Outpatients Clinics using Discrete Event Simulation. International Journal Simulation Model 11, vol.4 pp175-185.
  3. Alcalde-Rabanal JE., Lazo-González O., Nigenda G., 2011. Sistema de salud en el Perú. Salud Publica de Mexico. Vol. 53, num. 2, pp. s243-s254.
  4. Brenner S., Zeng Z., Liu Y., Wang J., Li J., Howard P., 2010. Modeling and Analysis of the Emergency Department at University of Kentucky Chandler Hospital Using Simulations. Journal of emergency nursing. Vol 36, issue 4, pp 303-310.
  5. Cabrera E., Taboada M., Iglesias M., Epelde F., Luque E., 2012. Simulation Optimization for Healthcare Emergency Departements. Proceedings of the International Conference on Computational Science, ICCS 2012. Vol 9, pp 1464-1473.
  6. Central Intelligence Agency. The World Factbook. Retrieved from https://www.cia.gov/library/ publications/the-world-factbook/fields/2226.html#179.
  7. Dirección General Parlamentaria, 2010. Carpeta Georeferencial. Retrieved from http:// www.congreso.gob.pe/adlp/georeferencial/2013/1trim estre/20.PIURA.pdf.
  8. Holm L., Luras H., Dahl F., 2012. Improving hospital bed utilisation through simulation and optimization with application to a 40% increase in patient volume in a Norwegian general hospital. International Journal of Medical Informatics. Vol. 82, issue 2, pp 80-89.
  9. Hoot N., LeBlanc L., Jones I., Levin S., Zhou C., Gadd C., 2008. Forecasting Emergnecy Department Crowding: A Discrete Event Simulation. Annals of Emergency Medicine. Vol. 52, issue 2, pp. 116-125.
  10. Instituto Nacional de Estadística e Informática, INEI, 2012. SERIES NACIONALES. Retrieved from http://series.inei.gob.pe:8080/sirtod-series/
  11. Jahn B., Theurl E., Siebert U., Pfeiffer K., 2010. Tutorial in Medical Decision Modeling Incorporating Waiting Lines and Queues Using Discrete Event Simulation. Value in Health. Vol. 13. Num 4. Pp 501-506.
  12. Jamon P., Lin L., 2012. Models for improving patient throughput and waiting at hospital emergency departments. Journal of Emergency Medicine. Vol. 43, issue 6, Pp-1119-11268.
  13. Kelton W., Sadowski R., Zupick N., 2009. Simulation with Arena, McGraw-Hill. New York, 5th edition.
  14. Law AM., Kelton D., 2007. Simulation modeling and analysis, McGraw-Hill. New York, 4th edition.
  15. Ministerio de la Salud, MINSA. Observatorio de Calidad en la Salud Reports. Retrieved from http:// www.minsa.gob.pe/dgsp, 11/8/2013 (date accessed).
  16. Troy P., Rosenberg L., 2009. Using simulation to determine the need for ICU beds for surgery patients. Surgery. Vol 146, num 4, pp608-620.
  17. Villamizar JR., Coelli FC., Pereira W., Almeida R., 2011. Discrete-event computer simulation methods in the optimisation of a physiotherapy clinic. Physiotherapy. Vol 97. Pp. 71-77.
  18. Werker G., Sauré A., French J., Shechter S., 2009. The use of discrete-event simulation modeling to improve radiation therapy planning process. Radiotherapy and Oncology vol 92, pp 76-82.
  19. Zeng Z., Ma X., Hu Y., Li J., Bryant D., 2012. A simulation study to improve quality of care in the emergency department of a community hospital. The Journal of nursing. Vol. 38, issue 4, pp 322-328.
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Paper Citation


in Harvard Style

Quevedo V. and Chapilliquen J. (2015). Modeling a Public Hospital Outpatient Clinic in Peru using Discrete Simulation . In Proceedings of the International Conference on Operations Research and Enterprise Systems - Volume 1: ICORES, ISBN 978-989-758-075-8, pages 389-394. DOI: 10.5220/0005271903890394


in Bibtex Style

@conference{icores15,
author={Valeria Quevedo and Javier Chapilliquen},
title={Modeling a Public Hospital Outpatient Clinic in Peru using Discrete Simulation},
booktitle={Proceedings of the International Conference on Operations Research and Enterprise Systems - Volume 1: ICORES,},
year={2015},
pages={389-394},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0005271903890394},
isbn={978-989-758-075-8},
}


in EndNote Style

TY - CONF
JO - Proceedings of the International Conference on Operations Research and Enterprise Systems - Volume 1: ICORES,
TI - Modeling a Public Hospital Outpatient Clinic in Peru using Discrete Simulation
SN - 978-989-758-075-8
AU - Quevedo V.
AU - Chapilliquen J.
PY - 2015
SP - 389
EP - 394
DO - 10.5220/0005271903890394