A Three-Level Strategy for the Design and Performance Evaluation of Hospital Departments

The efficient management of hospital departments (HDs) has recently become an important issue. Indeed, the increased demand and design for hospital services have saturated the capacity of HD that requires suitable tools for the efficient use of resources and flow of patients, staff, and drugs. This paper proposes a model based on a three-level strategy to design at the tactical level in a concise and effective way the structure, the resources, and the dynamics of a critically congested HD. The design strategy is composed of three basic elements: the modeling module, the optimization module, and the simulation and decision module. The first module employs a Unified Modeling Language tool and a timed Petri net (PN) model to effectively capture the detailed flow and dynamics of patients, starting from their arrival to the HD until their discharge. The optimization module employs the fluid relaxation to concisely approximate in a continuous PN framework the HD model and optimize suitable performance indices. The simulation module verifies that the optimized parameters allow an effective workflow organization while maximizing the patient flow. In case of inconsistencies due to the fluid approximation between the continuous model used in the design phase by the optimization module and the discrete one used in the subsequent verification phase by the simulation module, the latter module revises the values of some HD model parameters. A real case study on the Emergency Cardiology Department of the General Hospital of Bari (Italy) shows the efficiency and accuracy of the proposed method.