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Original Article

Performance evaluation of an emergency department in Rio de Janeiro: a hybrid approach using Discrete Events Simulation and Data Envelopment Analysis

Avaliação de desempenho do atendimento em uma emergência hospitalar do Rio de Janeiro: uma abordagem híbrida por meio de Simulação de Eventos Discretos e Análise Envoltória de Dados

Luís Filipe Azevedo de Oliveira; Igor Tona Peres; Bianca Menezes Araujo

http://dx.doi.org/10.1590/1806-9649-2024v31e1024 Gest. Prod., vol.31, e1024, 2024
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Abstract

Abstract: The efficiency and quality of the emergency department are paramount to ensure that patients receive immediate and appropriate care. Issues such as lengthy waiting times, critical resource management and allocation, and patient scheduling are linked to increased morbidity and mortality, particularly among the elderly and vulnerable populations. This study aims to assess the performance of an emergency department hospital in Rio de Janeiro based on the analysis of resource utilization and queue performance. The methodology encompassed the development of the emergency macro-process, a preliminary statistical analysis of the collected data, and discrete event simulation under different demand conditions. The study found that the average length of stay in the emergency department was 58.12 minutes, potentially increasing to 104.58 minutes under a 15% demand stress. Improvement scenarios were tested, and their efficiencies were measured using data envelopment analysis in an output-oriented and constant return to scale model. The sensitivity analysis revealed that the proposed performance enhancements could make the hospital more responsive to demand peaks and emergencies, ensuring greater resilience and better resource utilization under adverse conditions.

Keywords

Discrete Events Simulation, DES, Data Envelopment Analysis, DEA, Emergency

Resumo

Resumo: A eficiência e a qualidade do setor de emergência são essenciais para garantir sua segurança e integridade dos pacientes. Problemas como espera prolongada, gestão e alocação de recursos críticos estão associados ao aumento da morbidade e mortalidade dos pacientes, especialmente entre a população em situações de risco. Este trabalho avalia o desempenho de uma emergência hospitalar localizado no Rio de Janeiro/RJ, baseando-se na utilização dos seus recursos e desempenho de filas. A metodologia inclui o desenvolvimento do macroprocesso da emergência, análise estatística preliminar dos dados e modelo de simulação de eventos discretos sobre diferentes condições de demandas. O tempo médio de permanência na emergência é de 58,12 minutos nos meses de maior demanda e passaria para 104,58 minutos, diante de um estresse de 15%. Diferentes cenários de melhorias foram testados e suas eficiências foram mensuradas por meio de análise envoltória de dados, num modelo que considera orientação ao output e retorno de escala constantes. A análise de sensibilidade realizada em um dos cenários eficientes revelou que o desempenho proposto pode tornar o hospital mais responsivo a picos de demanda e situações emergenciais. Isso garante ao hospital maior resiliência e um melhor aproveitamento dos recursos em condições adversas.

Palavras-chave

Simulação de Eventos Discretos, SED, Análise Envoltória de Dados, DEA, Emergências

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