Running head: Emergency Department in Mubarak Hospital
Systems Simulation (IE580):
Title: Emergency Department in Mubarak Hospital
F3
Semester: Spring 2018
Final Report
Names ………………………………ID’s
Anaam Jumaah
25520
Hour Al-Jumah
25496
Loulwah Rabeea
17286
Instructor: Dr. Lawrence Al-Fandi
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Running head: Emergency Department in Mubarak Hospital
Table of Contents
Abstract .......................................................................................................................................... 4
Description of system ..................................................................................................................... 5
Objective ......................................................................................................................................... 5
Good candidate for simulation study .............................................................................................. 6
Background of the problem ............................................................................................................ 6
“What-if?” scenarios to be evaluated .............................................................................................. 7
Key performance indication ............................................................................................................ 8
Detailed process flow description and diagrams ............................................................................ 9
Boundaries of the system to be studied......................................................................................... 10
Determine Project constrains ........................................................................................................ 10
Input analysis Input analysis and its results .................................................................................. 11
Define system assumptions ........................................................................................................... 15
Define deliverables pertinent to the objective ............................................................................. 16
Our Model ..................................................................................................................................... 17
Description of the pieces of the Arena simulation model ............................................................ 18
Model verification and Validation ................................................................................................ 24
What if analysis results ................................................................................................................. 27
Output analysis of the simulation results ...................................................................................... 29
Recommendation and Conclusions ............................................................................................... 30
Project timeline ............................................................................................................................. 32
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Running head: Emergency Department in Mubarak Hospital
Table of Figures
Figure 1 flow chart about our system ............................................................................................. 9
Figure 2 Input Analyzer for emergency triage room data............................................................. 11
Figure 3 Empirical distribution for triage room ............................................................................ 11
Figure 4 Input Analyzer for visit the doctor for first time data .................................................... 12
Figure 5 Empirical distribution for seeing the doctor for the first time ........................................ 12
Figure 6 Input Analyzer for investigating room data.................................................................... 13
Figure 7 Input Analyzer for X-Ray room data.............................................................................. 13
Figure 8 Input Analyzer for observation room data...................................................................... 14
Figure 9 Input Analyzer for visit the doctor room for the second-time data ................................ 15
Figure 1 Arena Simulation of our model……………………………………………………….20
Figure 11 Gantt chart including activities for all project deliverables.......................................... 32
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Running head: Emergency Department in Mubarak Hospital
Abstract (Anaam Jumaah, Hour Aljumaah)
In our project, we will present the simulation study about one of the important hospitals in
Kuwait which is Mubarak hospital. As we know Mubarak hospital provides many services, but we
interested in the emergency department for many reasons. After we select our system we can build
real model system by using Arena programmer. In Addition, Arena software is a good tool to
design method for industrial engineering. Our next step will be gathering information related to
our system after we define the problem of the system. Then obtain our objective which is reduce
waiting time and increasing efficiency.
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Running head: Emergency Department in Mubarak Hospital
Description of system (Loulwah Rabeea)
To begin with, our project first, let's define our system which is Al Adan Hospital that located
in Hadiya area. Al Adan hospital was established in 1981 which is considered a government
hospital that served all layers of community. To discuss some of the departments that Al Adan
hospital cover which they are, medical department, surgical department, emergency department,
pediatrics department, dermatology department, ophthalmology department, orthopedics
department, and Neonatal Intensive care. So, our system that we will study about it is Al Adan
hospital, but we will choose some of the department that has highest waiting time. To start to
define our problem which is waiting time and longest queues in the emergency department that
patients faced every time when they go the hospital. After we define our problem and choose the
system. Next step will determine our objective from doing this project which solves the problem
they faced and decreasing the waiting time for patients. Also, we will try to work in the utilization
which is show the performance of simulation system. Another goal we want to achieve is building
a real model that can proportional to modern standards.
Objective (Loulwah Rabeea)
Our goal from doing this project is building simulation model near to real life for Mubarak
hospital that can help to improve the performance of the hospital. Also, we want to increase the
efficiency of a system. Addition to that decreasing the utilization. Moreover, decreasing the
waiting time that helps to reduce noise in hospital. And improve service that provides for patients
and provides the good environment. The last objective divides the patient equally according to
their need queues.
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Running head: Emergency Department in Mubarak Hospital
Good candidate for simulation study (Loulwah Rabeea)
The reason behind choose the Al Adan hospital is developing one of the important hospitals
in Kuwait because we notice the low services conclude to a big problem that needs to development
of health services. The second reason that encourages us to choose is as a system is appropriate for
building simulation model and have the requirement that we need for our project. Another reason
is we found that Al Adan hospital has a low efficiency which Arena programmer work can help
us to increase the efficiency in short time. Finally, after we provide the reason for choosing the
system know we can collect the data that requirement for building a real model by using Arena
programmer.
Background of the problem (Loulwah Rabeea)
As we know that patients come in emergency department suffer from many problems or
accident that occur suddenly like, burning, falling, poisoning, and suffocation. Which create a
crowded environment for the patient and lead to long waiting time. So, the patients have to wait to
get their care, but the problem in the times that they spend to get the treatment. Also, the emergency
department is the most important department in the hospital that can affect the life people. And the
system that we choose is Mubarak hospital that all the time crowded any service many areas near
to the Jabriya. Also, Mubarak hospital is a public hospital that provides health care of all
nationalities. So, in our project, we define the department which is emergency. Then we introduce
the process that emergency department provides for their patients. After that, we collect certain
data that we need to build simulation model by using arena model. Which can help us to improve
the emergency department performance and eliminate crowded environment by giving us the best
solution?
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Running head: Emergency Department in Mubarak Hospital
There are categories to divide the level risk of a patient depends on the degree of risk: the first
level is resuscitating which the patients do not wait in waiting room, but unfortunately, this level
does not include the system because it has the separate system. The second level is emergent, the
third level is urgent, the fourth level is less urgent. And the last level is not urgent. And from
second to fifth will be included in the simulation study by calculating the number of queuing and
waiting time in queuing.
“What-if?” scenarios to be evaluated (Anaam Jumaah, Hour Aljumaah)
As industrial engineer we have many suggestions to improve our system which are:
1-adding a self-service machine to help the patients to receive his or her own number with triage
assessment sheet. Because we want to reduce number of waiting in reception and reduce the cost
because there is no need for hiring reception workers.
2- suggest to make the nurses in triage room do the job of the investigation because we have only
one nurse in investigation room and two nurses in triage room to decrease waiting time.
3-
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Running head: Emergency Department in Mubarak Hospital
Key performance indication (Loulwah Rabeea)
A key performance indicator is tools used to compare the performance and goal of a hospital
that they want to archive. To start with the performance of Mubarak hospital, it needs to improve,
evaluate, and monitoring to be competitive with another hospital. Although Mubarak hospital has
many issues need to fix, so we focused on failure system that happens any time and disables many
patients from getting their treatment in fast time. For Mubarak Hospital we measured queue length
of each process, the service time of patients from entering till leaving the hospital.
The service time is in:
 Investigation room
 Observation room
 Hospital reception
 X-Ray room
 Pharmacy
And for key performance indicators, we will calculate the throughput of patients since the number
of throughput increase effectively which had the bad effect in a service.so by adding a record to
measure the mix rate of production that hospital provides for their patients. Also, we will notice if
it need to improve to get better efficiency. On another hand, we calculate cycle time for a hospital
which the time patients until leaving the hospital. Also, see if the cycle time at a normal rate or
need to fix by improving the service and quality of the hospital.
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Running head: Emergency Department in Mubarak Hospital
Detailed process flow description and diagrams (Anaam Jumaah, Hour Aljumaah)
Figure 2 flow chart about our system
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Running head: Emergency Department in Mubarak Hospital
Boundaries of the system to be studied (Anaam Jumaah, Hour Aljumaah)
We study the emergency department in Al-Mubarak hospital. Our boundaries are measure
the number of patient, X-Ray room, doctor room, the arrival time, and number of doctor and their
working times in hours per shift. Also, find the service time in the reception of emergency
department; in addition, measure the service time for required measurement in the emergency
triage room like blood pressure and temperature, etc. Also, measure service time spend in the
doctor room, investigation, X-Ray, and observation room; furthermore, waiting time in the
pharmacy. Moreover, measure the waiting time and cycle time.
Determine Project constrains (Anaam Jumaah, Hour Aljumaah)
In our system we have only one constraint which is the emergency department in Mubarak
hospital only receive patients from Mubarak AL Kabeer governorate. But they don’t have
constraints like max arrival or first creation, because it is emergency department. Also, it opened
for 24 hours.
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Running head: Emergency Department in Mubarak Hospital
Input analysis Input analysis and its results (Anaam Jumaah, Hour Aljumaah)
1) For Emergency Triage room:
Figure 3 Input Analyzer for emergency triage room data
First of all, we have lognormal distribution with two test which is Chi- Square test. In addition, we
assume that alpha is equal to 0.05. The corresponding p-value for Chi- square test is equal to 0.005
which is less than alpha, so we will reject, so we will use empirical distribution.
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Figure 4 Empirical distribution for triage room
Running head: Emergency Department in Mubarak Hospital
2) Visit the Doctor for the first time:
Figure 5 Input Analyzer for visit the doctor for first time data
We assume alpha is equal 0.05 then we find the Corresponding p-value equal 0.005 which is less
than alpha. We will reject because we don’t have enough evidence to accept, so we use empirical
distribution.
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Figure 6 Empirical distribution for seeing the doctor for the first time
Running head: Emergency Department in Mubarak Hospital
3) For investigating room:
Figure 7 Input Analyzer for investigating room data
4) For X-Ray room:
Figure 8 Input Analyzer for X-Ray room data
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Running head: Emergency Department in Mubarak Hospital
5) For Observation room:
Figure 9 Input Analyzer for observation room data
We assume alpha is equal 0.05 then we find the Corresponding p-value equal 0.15 which is greater
than alpha. we will accept because we don’t have enough evidence to reject, so Gamma distribution
it is good presentation for our data.
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Running head: Emergency Department in Mubarak Hospital
6) Visit the doctor room for the second time:
Figure 10 Input Analyzer for visit the doctor room for the second-time data
Define system assumptions (Anaam Jumaah, Hour Aljumaah)
the emergency department in Mubarak hospital there are many assumptions. First, they
have two rooms and each room have one doctor with one nurse and the doctors work 8 hours shift.
Second, there are 2 X-Ray rooms with 5 workers. Third, two emergency triage room one for female
and the other is for male with 2 nurses in each of them. Fourth, one investigation room with one
nurse. Finally, two observation room one for female and one for male and there are 8 nurses
Moreover, the test of the blood in observation room always take 2 hours. In addition, we collect
the data many times in the weekend at morning and at night. Also, in the weekdays at the morning
and at night. So, at each time the number of arrival are different and we calculate the arrival for
24 hours for 7 days.
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Running head: Emergency Department in Mubarak Hospital
The percentages of our system assumption:
Department
Some patients that we calculate
All the patients
Emergency triage room
100%
100%
Doctor room for the first time
100%
100%
Investigation room
35%
90 - 100%
X-Ray
60%
100%
Observation room
30%
95%
Doctor room for the second time
90%
95%
Pharmacy
95%
100%
Define deliverables pertinent to the objective (Anaam Jumaah, Hour Aljumaah)
Our recommendation for improvement are make the shift after 6 hours instead of 8 and that
will reduce the stress; in addition, the best number of the doctor is four for each shift instead of 2.
Also, each doctor will have one nurse. Moreover, it will benefit the hospital with good reputation.
Also, if the utilization increase the profit will increase.
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Running head: Emergency Department in Mubarak Hospital
Our Model
Figure 11 Arena Simulation of our model
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Running head: Emergency Department in Mubarak Hospital
Description of the pieces of the Arena simulation model (Anaam Jumaah, Hour Aljumaah)
The model starts with create which the type is schedule, so we have to go to the schedule table
and define the value and the duration for 24 hours and 7 days of patient arrive and all the unit for
the model in hours.
The assign after the create for two things which are priority and patient arrive which is for cycle
time. Both of them the type is attribute. The steps for the priority after we assign it are
1- Decide 2 -way by chance with 50% for decide elderly patient
2- Two assigns on of them without priority and the other priority for elderly patient which
we put priority for the same name of the first assign which if priority
3- Process which have resource which area doctor and nurse, delay type is expression then
we go to queue table the type is highest attribute value and the attribute name is priority
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Running head: Emergency Department in Mubarak Hospital
The new value for this assign is TNOW then we put record before dispose which the attribute
name should have the same name of the assgin which is patient arrive .
After the first assign there is process for reception and the resource are worker. For each patient
the minimum number of waiting is 0.017 which mean 1 minute and the maximum 0.05 which
mean 3 minutes. After, that decide for the male and female by 50% then divide them by two
process triage male room and triage female room and both of them have different expression.
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Running head: Emergency Department in Mubarak Hospital
In the decide, we put the type as N-way by chance because we have eight possible probability for
our model.
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Running head: Emergency Department in Mubarak Hospital
After that, we do assign for each sequence and we choose the attribute name as entity
sequence and the new value is s1 which mean sequence one. Also, we choose another attribute
name which entity picture is. We do the same step for all the assigns but with different sequence
number. Then we go to sequence in advanced transfer and we write in each sequence it routes
which are:
Part 1: Observation, See the Dr again, Pharmacy
Part 2: Investigation, Pharmacy
Part3: Investigation, See the Dr again, Pharmacy
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Running head: Emergency Department in Mubarak Hospital
Part4: X-ray, See the Dr again
Part5: X-ray, See the Dr again, Pharmacy
Part6: Investigation, X-ray, See the Dr again, Pharmacy
Part7: X-ray, Observation, See the Dr again, Pharmacy
Part8: Investigation, Observation, See the Dr again, Pharmacy
And for each part when they finish they exit the hospital.
Here we put enter and route so that the patient enters the room then they see their route
depending on their sequence. And we choose the destination type for route by sequence.
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Running head: Emergency Department in Mubarak Hospital
We put all the station that the patient might go through them. After that it goes through the process
and then see it route until he exits the hospital.
And for each process we will choose seize delay release and we put the delay time as expression
and we put the time. There is different time for each process.
In the resource, we put the capacity for each resouce in each process.
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Running head: Emergency Department in Mubarak Hospital
Model verification and Validation
We choose to measure the cycle time for the system:
1- When number of replication= 1
The half width is insufficient which mean the number of replication is not enough, so we
have to increase it.
2- When number of replication=5
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Running head: Emergency Department in Mubarak Hospital
We measure the p-value to see if this replication is good or no, so we take the half width divide
by the average and we see if the p-value is less than the error and we assume the error equal to
0.05. 𝑝 − 𝑣𝑎𝑙𝑢𝑒 =
ℎ𝑎𝑙𝑓 𝑤𝑖𝑑𝑡ℎ
𝑎𝑣𝑒𝑟𝑎𝑔𝑒
18.2
= 92.2744 = 0.14 > 0.05. and we see that the p-value is bigger than
the error, so we have to increase the number of replication.
3- When number of replication=100
10.95
Here we calculate the p-value again 𝑝 − 𝑣𝑎𝑙𝑢𝑒 = 93.6562 = 0.02 < 0.05 and we can see that the
p-value is less than the error, so we will use this equation 𝑛 ≅ 𝑛 ⃘ ∗
ℎ °2
ℎ2
18.22
= 5 ∗ 1.952 = 435 is a
good replication number, so we put it in the run setup.
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Running head: Emergency Department in Mubarak Hospital
4- When number of replication=435
We will check again if 435 is good replication by do run and calculate the p-value and we get it
equal to 0.008 less than 0.05 which is the error, so 435 is a good number of replication.
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Running head: Emergency Department in Mubarak Hospital
What if analysis results
First, we put the capacity as we take from the hospital:
Then we see the utilization for this model:
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Running head: Emergency Department in Mubarak Hospital
Second, we change the capacity for improvement and we find the utilization for this model:
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Running head: Emergency Department in Mubarak Hospital
Output analysis of the simulation results
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Running head: Emergency Department in Mubarak Hospital
We do the cycle time for system for our model before and after the improvement
Recommendation and Conclusions
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Running head: Emergency Department in Mubarak Hospital
To conclude,
We want to reduce the waiting time in Emergency Department in Mubarak Hospital by
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Running head: Emergency Department in Mubarak Hospital
Project timeline
Figure 12 Gantt chart including activities for all project deliverables
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