Real-time simulation as a way to improve daily operations in an emergency room

Emergency Rooms (ER) are resource constrained systems that demand efficient management in order to fulfill their care and service objectives. This article explores the use of real-time simulation to improve daily operations at an ER where unplanned events may occur. Such a simulation model must adequately portray the current state of the system; however ER workflow management systems often provide only limited information for this purpose. This paper studies the impact of the model's ability to predict ER performance with a limited amount of input information, such that what-if questions may be asked to guide decision making. Towards this end, two input data scenarios are compared to a case of perfect information. One scenario considers only patient arrival times and the other assumes additional knowledge of patient care pathways. Although both generate similar performance measures, the case with least information yields a slightly worse estimate of patient care pathway composition.