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Title: Documented patients' journeys through an Emergency Department as the basis for a discrete event simulation model using data from University of Benin Teaching Hospital (Nigeria) and Manchester Royal Infirmary (United Kingdom)
Author: Ugbi, Blessing Afokoghene
ISNI:       0000 0004 5357 9474
Awarding Body: University of Manchester
Current Institution: University of Manchester
Date of Award: 2015
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This work compares the procedures used in the Emergency Departments in the University of Benin Teaching Hospital (UBTH) in Nigeria and in Manchester Royal Infirmary (MRI) in the UK. It goes on to develop a discrete event model of the latter in Rockwell Arena®.Raw data from UBTH were obtained over a number of visits by interviewing senior administrators, clinicians and nursing staff and by tracking patients over a period of 2 months between 1 July and 29 August, 2011. Information from MRI was supplied through an approved ethical protocol to the National Research Ethics committee (REC Reference 13/NN/0175, IRAS ID 124168, dated March 4, 2013). This embraced patient journeys, locations, investigations and tests for the 98236 patients who attended the ED between April 2012 and March 2013. These (anonymised) data were obtained as spreadsheets from the original Symphony® records, which were then manipulated and analysed using the computer language, R. Anecdotal information on ED operations, patient flow and procedure duration times were also obtained from ED staff. All of this information identified similarities and differences between patient journeys in the two hospitals and were used to generate appropriate process maps. Proposals were made to improve the recoding and maintenance of patients’ records in UBTH. In the case of MRI, each patient’s journey was expressed as a journey-string, which was an ordered list of locations and milestones derived from the time-stamps recorded in the original spreadsheets. A large transition matrix (168 by 168) was generated from the set of journey strings and established the probability of a patient going from one location to any another. This reflects all the decisions which were made at each step of the patient’s journey. The number of destinations from a particular source reflects the options available at a particular instant in time, while the size of each probability reflects the preferred destination. The transition matrix together with the duration and resource requirement of the process associated with the destination is the key to the generation of a process map for each journey through the system. This methodology is original and can be applied generally. This was used as a basis for the journey-path model. In the final MRI model the 4h deadline was not included since the mechanism for its actual implementation was somewhat vague. Instead some isolated models based on patients’ priorities and resource re-allocation were described. From these it was inferred that changing the priority of a patient may not in itself be sufficient to alter the journey profile and in order to do so resources must be re-allocated. The only alternative would appear to be the fast-tracking of patients.
Supervisor: Not available Sponsor: Schlumberger Faculty for the Future Foundation
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Emergency Department ; Simulation Modelling