A simulation-based decision support tool to analyze clinical pathways in hospital

In this chapter we analyze the patient flow inside a hospital surgical department, adopting a patient-centered perspective focused on clinical pathways (CPs). The specific aim is to develop a decision support tool to make the clinical point of view, implicit in the CP approach, compatible with the economic and managerial requirements of the hospital. The simulation-based modeling framework herein proposed analyzes the three main operative areas, or sub-processes, of the flow of surgical patients within the hospital, i.e. waiting list management, operating theatre planning and bed ward organization. The framework has been applied to a university public hospital in Genova (Italy). Firstly, the simulation model has been used to compare alternative scenarios, changing waiting list and bed management strategic decisions, through a complete set of indexes able to capture the performance of the three sub-processes, with parity of resources. Secondly, the model has been adapted to evaluate the impact on the overall department performance of iteratively introducing the solutions given by a 0-1 optimization model developed to solve the tactical operating room planning problem. The reported results show that the integrated decision tool can be helpful in supporting decisions that are particularly hard in healthcare delivery because they usually imply a tradeoff between different performance indexes.