The emergency department is the patients’ main entrance to the hospital, which operates 24 hours a week to treat various types of illnesses categorized as emergencies. Therefore, many patients tend to seek treatment in this department, especially after office hours. The main function of the emergency department is to treat critical or semi critical cases. Nevertheless, this department has also become a place to treat patients with non-critical cases. The presence of a high number of patients every day has caused the emergency department to often face overcrowding. Realizing this fact, the management needs to curb this issue as soon as possible. Therefore, this paper discusses the application of the Discrete Event Simulation approach in modeling the daily operation of the Green Zone of the emergency department under study. The simulation model was developed using Arena simulation software to understand the behaviors of the system operation. Besides, from the simulation model, the management can identify the bottlenecks of the system which contribute to the high patients’ waiting time and length of stay as well as the utilization rate of the resources. The simulation outputs show that waiting for available resources is the main issue that creates overcrowding in the waiting area of the Green Zone. A few alternative solutions were designed and discussed with the management of the emergency department for possible improvements. The results from the improvement model show a significant reduction in a patient’s waiting time as well as a patient’s length of stay. This improvement model also stabilized the utilization rate of the involved resources.
Anon. (2019). Kesesakan di Jabatan Kecemasan hospital kerana kunjungan pesakit melebihi 'level of care'. Retrieved from
https://www.bharian.com.my/berita/nasional/2019/07/585386/kesesakan-di-jabatan-kecemasan-hospital-kerana-kunjungan-pesakit
Azlan, N., Saibon, I. M., & Azizol, M. (2013). Management of emergency department overcrowding (EDOC) in a teaching hospital. Medical and Health 8(1): 42 – 46.
Boyle, A., Beniuk, K., Higginson, I., &Atkinson, P. (2012). Emergency Department Crowding: Time for Interventions and Policy Evaluations. Emergency Medicine International 2012: 2012:838610. doi: 10.1155/2012/838610.
Carson II, J. S., & John, S. (2002), Verification validation: model verification and validation. Proceedings of the Winter Simulation Conference, USA, 52-58. Retrieved from https://www.informs-sim.org/wsc10papers/016.pdf
Carson II, J. S. (2005). Introduction to Modeling and Simulation. Proceedings of the 2005 Winter Simulation Conference, edited by M. E. Kuhl et al. (Orlando, FL, 2005), pp. 16-23.
Chen, T. L., & Wang, C. C. (2015). Multi-objective simulation optimization for medical capacity allocation in emergency department. Journal of Simulation 10(1), 50 – 68.
Darraj, A., Hudays, A., Hazazi, A., Hobani, A., & Alghamdi, A. (2023). The Association between Emergency Department Overcrowding and Delay in Treatment: A Systematic Review
Erenler, A. K., Akbulut, S., Guzel, M., Cetinkaya, H., Karaca, A., Turkoz, B., & Baydin, A. (2016). Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital. Turkey Journal Emergency Medicine 14(2), 59 – 63.
Farahi, S., & Salimifard, K. (2021). A simulation–optimization approach for measuring emergency department resilience in times of crisis. Operations Research for Health Care, 31. https://doi.org/10.1016/j.orhc.2021.100326
Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: causes, effects, and solutions. Annals of Emergency Medicine 52(2), 126 – 136.
Ibrahim, I. M., Liong, C. Y., Bakar, S. A., Ahmad, N., & Najmuddin, A. F. (2017). Minimizing patient waiting time in emergency department of public hospital using simulation optimization approach. In AIP conference proceedings (Vol. 1830, No. 1, p. 060005). AIP Publishing LLC.
Kelton, W. D., Sadowski, R. P., & Zupick, N. B. (2015), Simulation with Arena. McGraw-Hill.
Kozan, E., & Diefenbach, M. (2008). Hospital Emergency Department Simulation for Resource Analysis. IEMS, 7(2), 133 – 142.
Latif, A. A. (2017). Masyarakat perlu faham fungsi jabatan kecemasan dan trauma. Hospital Universiti Sains Malaysia Portal. Retrived from
https://dformulary.h.usm.my/index.php/en/news-archieve/44-berita-2017/620-masyarakat-perlu-faham-fungsi-jabatan-kecemasan-dan-trauma
Law, A. M., & McComas, M. G. (2001). How to build valid and credible simulation models. Proceedings of the Winter Simulation Conference, USA, 22 – 29. doi: 10.1109/WSC.2001.977242.
McKenna, P., Heslin, S. M., Viccellio, P., Mallon, W. K., Hernandez, C., & Morley, E. J. (2019). Emergency department and hospital crowding: causes, consequences and cures. Clinical and Experimental Emergency Medicine 6(3), 189 – 195.
Medical Development Division. (2012). Emergency Medicine and Trauma Services Policy. Institute of Medical Research.
https://www.moh.gov.my/moh/resources/Polisi/EMTS_Book.pdf
Ministry of Health Official Portal. (2023) Retrieved from https://www.moh.gov.my/index.php/pages/view/2003?mid=688
Morley, C., Unwin, M., M. Peterson, G., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: A systematic review of causes, consequences and solutions. https://doi.org/10.1371/journal.pone.0203316.
Nahhas, A., Awaldi, A., & Reggelin, T. (2016). Simulation and the Emergency Department Overcrowding Problem. Procedia Engineering, 178(2017), 368-376.
Salvatore, S., Paladino, L., Vaughan, L., & Lalle, I. (2014). Overcrowding in emergency department: an international issue. Internal and Emergency Medicine 10(2), doi:10.1007/s11739-014-1154-8
Salway, R. J., Valenzuela, R., Shoenberger, J. M., Mallon, W. K., & Viccellio, A. (2017). Emergency Department (ED): Evidence Based Answers to Frequently Asked Questions. Revista Médica Clínica Las Condes 28(2), 213 – 219.
Shannon, R. E. (1998). Introduction to the Art and Science of Simulation. Proceedings of the 1998 Winter Simulation Conference, edited by D. J. Medeiros et al. (Washington, DC, 1998), pp. 7-14.
Aminuddin, W. M. (2018). Pengoptimuman sumber di jabatan kecemasan PPUKM menggunakan simulasi acara diskret dan analisis pengumpulan data [Doctoral dissertation, Universiti Kebangsaan Malaysia
