The Development and Validation of a Novel Discrete Simulation Tool for Modeling the Operational Efficiency of Inpatient Electrophysiology Services

OBJECTIVES: The demand for inpatient cardiac electrophysiology (EP) treatment in China is growing rapidly, outpacing the growth of required healthcare resources. Multiple operational and technological improvements may lead to different levels of operating efficiency improvement for EP centers. In this study, we developed and validated a discrete event simulation (DES) model for the inpatient care of EP patients. The model may serve as a tool for decision-makers to evaluate, compare, and prioritize different strategies to improve care delivery efficiency.

METHODS: A DES model was built by incorporating tertiary hospital clinicians’ inputs to simulate the journey of the individual EP patient from admission to discharge. Scheduling of limited resources (beds, EP laboratories, electrophysiologists, etc.) was explicitly considered. The model also includes resource competition among EP patients with non-EP patients in the cardiology ward. Costs and operational details were tracked and reported by the mode. Model validation was performed by comparing the mean simulation results from 1000 probabilistic runs with real-world EP patient admission statistics and length of stay (LOS) from the Cardiology Department of the First Affiliated Hospital of Zhejiang University (CDFAHZU).

RESULTS: CDFAHZU has 87 beds and four catheterization laboratories with two assigned to EP procedures. The simulated daily average of EP procedures delivered vs. the real-world daily EP procedure count were 2.70 and 2.80, respectively. The mean simulated LOS was 3.79 days vs. the observed LOS of 3.89 days. The simulated monthly EP patient discharge count was 76.4, compared to the observed 77. All real-world average values used in the validation are within the 95% credible intervals of simulation results.

CONCLUSIONS: The DES model properly captured the cardiac EP patient journey, and the model simulation outputs were consistent with real-world observation. The DES model can serve as a strategic tool for evaluating initiatives to improve operational efficiency.