A Simulation Approach to Analyze the Operational Response Plans in an Emergency Department Under the COVID-19 Pandemic

Emergency departments in hospitals are a crucial part of the healthcare systems around the world. They provide emergency medical services to patients who need urgent treatments. Due to the multiple sources of variability and uncertainty in their operations, they are considered complex systems. In addition, since the onset of COVID-19, hospitals have adapted their operations to decrease the contact between patients and medical staff to minimize the infection rate. In this work, we study the operations of an emergency department which made changes in its processes as a strategy to face the COVID-19 pandemic. The changes include the incorporation of a new area for respiratory patients, reallocating resources, and the modification of the patients’ journey in the emergency department. We propose a discrete event simulation approach to represent the operations before and after the changes in the emergency department services. The proposal was developed with collaboration of the emergency department managers and validated using the performance measures before the start of the COVID-19 pandemic. The main computational results show that the changes in the emergency department were effective to distribute the limited resources and limit the medical staff and non-respiratory patients’ exposure to suspected COVID-19 patients. However, in a post-COVID-19 scenario, such differentiation is no longer effective when the percentage of respiratory patients is less than 30%, since it increases the patients’ wait times, mainly for the non-urgent patients classified with less critical triage.