Simulation Modelling in the ED to Improve Service Levels & the Physical Plan

Emergency Departments (ED) play a crucial role in the Canadian healthcare system, serving significant volumes of population throughout the year. This environment is highly prone to such issues as prolonged lengths of stay and overcrowding. Reasons for these issues can be varied and difficult to identify. One of the ways to understand the patient flow in an ED is simulation modelling. Discrete event simulation (DES) is a powerful tool for modelling complex systems such as an Emergency Department. DES has been extensively used as a decision support system for stakeholders in healthcare systems across the globe.


The current simulation study focused on the modelling of St. Joseph’s Healthcare Centre’s ED and was conducted by LKS-CHART (St. Michael’s Hospital) and University of Toronto. The purpose of the work was two-fold. Firstly, we aimed to understand the current state of the ED, existing bottlenecks and potential challenges in maintaining and improving service levels to its patients while projecting increased patient volumes for the next ten years. Secondly, we aimed to understand the impact of potential opportunities for improving the patient flow, such as addition of extra physical space (i.e. stretchers and chairs), changes to staffing levels, as well as changes to some of the process flows.