Analysis of a hospital network transportation system with discrete event simulation

Abstract

VA New England Healthcare System (VISN1) provides transportation to veterans between eight medical centers and over 35 Community Based Outpatient Clinics across New England. Due to high variation in its geographic area, it has been a continuous challenge for VISN1 to develop an optimal transportation system that has low operation costs, little or no wait time for patients and drivers, and meets demand 100% of the time. Furthermore, complexities of operating a healthcare system have side effects on the transportation system, such as the inconsistencies in the patient scheduling system. Past research suggest that the decentralized nature of the VISN 1 transportation system has further negative effects on performance and that having a central transportation administration will increase efficiency and utilization of resources to improve both patient flow and quality of the current transportation system. This thesis attempts to illustrate the current issues of transportation with system design tools. Changes include having a centralized transportation system to standardize processes, reduce variation, and as a result, reduce variation and cost, while improving patient flow. In particular, discrete event simulation is used to analyze the flow of patients to the Boston medical center, the hub of VISNI medical centers. Although many shuttles come to Boston medical center daily, the ones that bring in the most number of patients were analyzed: Manchester, Togus, and White River. Two variables were tested: arrival times of shuttles and shuttle capacity. After generating simulation data and validating the results, the following trends were identified: (1) increasing the time interval between shuttles arrivals reduces patient wait time and (2) an extra shuttle is needed to accommodate patients when demand for transportation exceeds shuttle capacity.