Systems Modelling And Simulation Individual Resist Assignment
- Country :
Australia
A clinical centre in a war torn country in a remote area receives patients with various conditions. The clinic works 24 hours a day and admits two types of patients. Patient Type 1 (Low Priority): These are type of patients that are of low priority and they are normally treated by either the Clinical Nurses (CN) or the General Practitioners (GP). These patients arrive at the hospital with a rate Expo (20) min. They are seen by the admission officer, register and are sent to the Triage station. The registration follows POIS distribution with the following parameter (8) minutes. At the Triage station if a CN is available they are assigned to a nurse and only at special occasions if all the CNs are busy and if a GP is available the patient will be seen by the GP for assessment. If there are no Triage staffs available, the patients wait in the waiting area. This area has maximum capacity of 20 people (i.e. if the number in the queue behind the Triage is more than 20 the patient leaves the hospital). Report on the record of number of patients who leave the medical centre without being attended to. Patients that arrive during the break of the Admissions officer leave the system (record the number and report on this number of patients leaving due to admissions being closed)
The Triage processes consist of Patient Assessment, the assessment process follows a Triangular distribution with the following parameters (8, 12, 15) minutes. After the assessment process 85% of the patients are diagnosed, given medication by the Triage staff and leave the clinic. The remaining 15% have further complications that require further consultation with a GP in the Triage for further assessment. The processing time for these patients is Uniform (7, 10) minutes. 30% of these patients who have been diagnosed by the GPs need to be admitted to a bed for admission of drip medicine or monitoring and the rest of patients are discharged and leave the system. The admitted patients normally occupy the beds following a Triangular Distribution (10, 20, 35) hours.
All discharge processes require the chief nurse and one of the GPs (the less busy one) to assess the patient. This process takes a Weibull distribution (14, 18) minutes. The patient is provided with the necessary medication and leaves the system.
Patient Type 2 (High Priority):
Are patients with severe illnesses or wounds they are at a rate of Expo (220) minutes and take priority over the low priority patients. The high priority patient does not go through the admission process. These patients are assessed at the Triage by any available CN or GP and admitted to operation room (hint: this type of patients has higher priority to type 1 in the triage). There are 2 surgeons available and they conduct surgery from 9:00am to 6:00pm. Each surgery requires a surgeon, one of the 2 available Operation Rooms and one OR Nurse. The operation follows an Erlang Distribution with the following Distribution parameters (1, 2.3) hours. The queue behind the operation has maximum capacity of 10. Upon completion of the operation the patient is admitted to a bed in the Ward. The excess patients from queueing for Operation (more than 10 in the queue) are sent for transfer by the ambulance to the hospital.
There are a total number of 5 beds in the Clinic Ward and is shared between all patients that are admitted to the hospital (Low and High Priority Alike). The capacity of queue behind the ward is 3. If all beds are occupied or there is not enough space behind the operation rooms, the patient is transferred to a faraway hospital using the 2 available ambulances (Each ambulance is used half of the time). If neither beds nor ambulance is available the patient will lose his/her life.
The Operation Room relies on a power Generator that breaks down (making total operating room unusable) following a Poisson Distribution of 3 times a month with it taking Normal Distribution time of (2, 0.5) hours to fix.
The operation room has also a number of machines that need to be working during the operation. They are:
| Machines | Number Available | Mean time between failures (days), Rule | Out of Service Time (min) |
|---|---|---|---|
| ECG | 3 | Expo(10), Pre-empt | Triangular(30, 45, 60) |
| Resuscitation | 2 | Expo(15), Pre-empt | Triangular(120, 150,180) |
| Defibrillator | 2 | Expo(5), Pre-empt | Triangular (10, 30, 60) |
Patients can only be discharged between 8:00am-7:00pm. Any patient missing the 7:00pm Discharge would remain in the clinic occupying the bed until the following day to be discharged.
There are 2 Ward Nurses (WN) during the day and 1 at night shifts. The WN are assigned to all beds in ward and they monitor patients, one has to be present at any time. In the day each nurse has to go to a break at least every 6 hours. When both nurses are available they agree to take responsibility for one area of the Ward which is equally divided between them. The Clinical staff and admissions staff follow rotating shifts with the following schedules:
| Type | Number | Schedule | Rule |
|---|---|---|---|
| Admission & OR Nurse | 1 & 1 | 8:00-6:00pm Lunch Break 12:00-12:30, Afternoon Break 3:00-3:30 | Wait |
| CN | 2 | 8:00-7:00pm Lunch break one nurse at a time can be anytime between 12:00-2:00pm. Duration of break 30 minutes. Afternoon break between 3:00- 5:00pm only one can go on a break at each time. | Ignore |
| WN | 2 Days | Day shift 8:00-8:00pm - Lunch break one nurse at a time can be anytime between 12:00-2:00pm. Duration of break 30 minutes. Afternoon break between 3:00-5:00pm only one can go on a break at each time. Night Shift 8:00pm-8:00am the nurse will eat and drink whilst on watch (no breaks) | Wait |
| Chief Nurse,/td> | 1 | 8:00-7:00pm 12:00-1:00pm lunch break and hour 3:30-4:30 tea break in the afternoon. | Ignore |
| GP | 2 | 8:00-7:00pm Lunch break one nurse at a time can be anytime between 12:00-2:00pm. Duration of break 30 minutes. Afternoon break between 3:00- 5:00pm only one can go on a break at each time. | Pre-empt |
| Surgeons | 2 | 9:00am-6:00pm The surgeons are required to take 4, 30 minute breaks during their shift. They make sure that the surgeries are completed within the scheduled hours and make a round of the Ward after 6:00pm which normally takes 1 hour. | Wait |
| Ambulance | 2 | Available all the time. The round trip from the clinic to the hospital and back is 300 miles. Average speed is 65 per hour. | Wait |
Part 1 (35%):
Using Arena (enclose your CD), Warm-up Period = 12 hours, simulate the system 30 days. The number of Replications should be at least 5 (no initialisation of stats). Make sure you animate the system with a reasonable layout:
Using the results of the simulation answer and explain the following questions:
- What is the Total Number of patients by type that are treated in the clinic?
- What is the average waiting time for each type of patient?
- What is the average utilisation of all staff?
- What is the average time spent in the system by patient type?
- What is the average WIP by patient type?
- Identify the bottleneck of the system, if any exists, and explain why you think that they are bottlenecks of the system.
- How many patients are lost due to full queues and lack of resources (specify by type)? Explain the implications of such loss.
- What is the mortality rate?
- What happens to the mortality rate if an assumption is added that patients who wait in excess of 1 hour in the queue for transfer to hospital lose their lives?
- What is the ideal number in the queue behind the operation room or transfer to hospital that minimizes mortality rate?
NOTE: Model the ambulances in the Ward as transporters.
Part 2 (30%):
The clinical staff believes that the loss of patients due to overstretched resources is not acceptable. Using the results from the simulation of the actual system, suggest what sorts of changes are required both in staff and equipment that could improve the quality of service and reduce losses of lives:
- Reduce the number of lost patients due to long queues?
- Better utilization of the resources?
- What sort of support should the clinical staff require to reduce casualties?
- Reduce Mortality Rate
Part 3 (35%):
Assuming that the clinic has been promised with further funding, how would you recommend the funding to be spent? How would you priorities the allocation of resources. How many more beds, how many more staff with various specialities (Admission, Clinical and Ambulance)? How would you improve the availability of equipment with this fund? What is the distance between the current system and an ideal system in which key performance factors of the system are at optimal situation with balanced utilisation of resources and minimum casualty? Simulate the new system and extract what exactly is required to reach the optimum level of resources. Use your common sense in assessing the cost of staff, beds, equipment, ambulance, generator, etc. You may even use a simple financial analysis by allocating arbitrary but realistic cost against each resource.
Please enclose a print out of the Arenas final Summary Report (*.out) for each part of the assignment as an appendix to your report. The summary report is automatically generated by Arena in the same directory that you run and compile your model.
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