Journal of Healthcare Engineering

Journal of Healthcare Engineering / 2013 / Article

Research Article | Open Access

Volume 4 |Article ID 798050 |

Waressara Weerawat, Juta Pichitlamken, Peerapong Subsombat, "A Generic Discrete-Event Simulation Model for Outpatient Clinics in a Large Public Hospital", Journal of Healthcare Engineering, vol. 4, Article ID 798050, 22 pages, 2013.

A Generic Discrete-Event Simulation Model for Outpatient Clinics in a Large Public Hospital

Received01 Nov 2012
Accepted01 Feb 2013


The orthopedic outpatient department (OPD) ward in a large Thai public hospital is modeled using Discrete-Event Stochastic (DES) simulation. Key Performance Indicators (KPIs) are used to measure effects across various clinical operations during different shifts throughout the day. By considering various KPIs such as wait times to see doctors, percentage of patients who can see a doctor within a target time frame, and the time that the last patient completes their doctor consultation, bottlenecks are identified and resource-critical clinics can be prioritized. The simulation model quantifies the chronic, high patient congestion that is prevalent amongst Thai public hospitals with very high patient-to-doctor ratios. Our model can be applied across five different OPD wards by modifying the model parameters. Throughout this work, we show how DES models can be used as decision-support tools for hospital management.


  1. A. M. Law, Simulation Modeling & Analysis, McGraw-Hill, Inc., New York, 4th edition, 2007.
  2. S. G. Henderson and B. L. Nelson, Handbooks in Operations Research and Management Science: Simulation, Elsevier, Amsterdam, 2006.
  3. A. F. Seila and S. Brailsford, “Opportunities and challenges in health care simulation,” in Advancing the Frontiers of Simulation: A Festschrift in Honor of George Samuel Fishman, International Series in Operations Research & Management Science, pp. 195–229, Springer Science+Business Media, LLC, 2009. View at: Google Scholar
  4. M. L. Weng and A. A. Houshmand, “Healthcare simulation: a case study at a local clinic,” in Proceeding of the 1999 Winter Simulation Conference, P. A. Farrington, H. B. Nembhard, D. T. Sturrock, and G. W. Evans, Eds., pp. 1577–1584, 1999. View at: Google Scholar
  5. A. Raouf and M. Ben-Daya, “Outpatient clinic's staffing: a case Study,” International Journal of Health Care Quality, vol. 10, pp. 229–232, 1997. View at: Google Scholar
  6. Z. C. Zhu, B. H. Heng, and K. L. Teow, “Simulation study of the optimal appointment number for outpatient clinics,” International Journal of Simulation Modelling, vol. 8, no. 3, pp. 156–165, 2009. View at: Google Scholar
  7. A. Wijewickrama and S. Takakuwa, “Simulation analysis of appointment scheduling in an outpatient department of internal medicine,” in Proceeding of the 2005 Winter Simulation Conference, M. E. Kuhl, N. M. Steiger, F. B. Armstrong, and J. A. Joines, Eds., pp. 2264–2273, 2005. View at: Google Scholar
  8. S. Su and C.-L. Shih, “Managing a mixed-registration-type appointment system in outpatient clinic,” International Journal of Medical Informatics, vol. 70, pp. 31–40, 2003. View at: Google Scholar
  9. S. M. Ballard and M. E. Kuhl, “The use of simulation to determine maximum capacity in the surgical suit operating room,” in Proceeding of the 2006 Winter Simulation Conference, L. F. Perrone, F. P. Wieland, J. Liu, B. G. Lawson, D. M. Nicol, and R. M. Fujimoto, Eds., pp. 433–438, 2006. View at: Google Scholar
  10. F. F. Beasler, H. E. Jahnsen, and M. DaCosta, “The use of simulation and design of experiments for estimating maximum capacity in an emergency room,” in Proceeding of the 2003 Winter Simulation Conference, S. Chick, P. J. Sanchez, D. Ferrin, and D. J. Morrice, Eds., pp. 1903–1906, 2003. View at: Google Scholar
  11. G. Werker, A. Sauré, J. French, and S. Shechter, “The use of discrete-event simulation modelling to improve radiation therapy planning process,” Radiotherapy and Oncology, vol. 92, pp. 76–82, 2009. View at: Google Scholar
  12. C. Duguay and F. Chetouane, “Modeling and improving emergency department systems using discrete event simulation,” Simulation, vol. 83, no. 4, pp. 311–320, 2007. View at: Google Scholar
  13. S. Brenner, Z. Zeng, Y. Liu, J. Wang, J. Li, and P. K. Howard, “Modeling and analysis of the emergency department at university of Kentucky Chandler Hospital using simulations,” Journal of Emergency Nursing, vol. 36, no. 4, pp. 303–310, 2010. View at: Google Scholar
  14. V. A. Raghavan, V. Venkatadri, V. Kesavakumaran, S. Wang, M. Khasawneh, and K. Srihari, “Reengineering the cardiac catheterization lab processes: a lean approach,” Journal of Healthcare Engineering, pp. 45–65, 2010. View at: Google Scholar
  15. J. P. Oddoye, D. F. Jones, M. Tamiz, and P. Schmidt, “Combining simulation and goal programming for healthcare planning in a medical assessment unit,” European Journal of Operational Research, vol. 193, pp. 250–261, 2009. View at: Google Scholar
  16. J. R. Villamizar, W. C. A. Pereira, F. C. Coelli, and R. M. V. R. Almeida, “Discrete-event computer simulation methods in the optimisation of a physiotherapy clinic,” Physiotherapy, vol. 97, no. 1, pp. 71–77, 2010. View at: Google Scholar
  17. Q. Su, X. Yao, P. Su, J. Shi, Y. Zhu, and L. Xue, “Hospital registration process reengineering using simulation method,” Journal of Healthcare Engineering, vol. 1, pp. 67–82, 2010. View at: Google Scholar
  18. W. D. Kelton, R. P. Sadowski, and N. B. Swets, Simulation with Arena, McGraw-Hill, Inc, New York, 5th edition, 2010.
  19. J. Banks, J. S. Carson, B. L. Nelson, and D. M. Nicol, Discrete-Event System Simulation, Prentice-Hall, 5th edition, 2009.

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