A simulation optimization approach to investigate resource planning and coordination mechanisms in emergency systems

The aging population has a significant impact on the demand for emergency services worldwide. When the demand for these systems exceeds the available capacity, overcrowding occurs, leading to many negative consequences such as patient dissatisfaction, increased stress levels for caregivers, and financial loss for hospitals. Therefore, healthcare managers require decision support tools to rationalize their investment decisions and explore improvement opportunities throughout the emergency process. In this paper, a Discrete Event Simulation (DES) model is developed to capture the randomness and complexity of the entire emergency healthcare chain, including an Emergency Medical Service (EMS), an Emergency Department (ED), and an Observation Unit (OU). This tool was then embedded in a Simulation-Optimization (SO) approach that simultaneously optimizes resource planning decisions and ambulance relocation in the emergency process while exploring the potential benefits of coordination between different stakeholders in terms of joint decision making. Solutions of the SO approach were assessed by the DES model regarding a wide range of KPIs to support a multiobjective approach necessary to spotlight the decision maker choice. The results show that the coordination between the different sub-systems could remarkably improve the global performance of the system.