Alkan DURMUŞ, Ali ÖZDEMİR, Necati GÖKMEN

YOĞUN BAKIM ÜNİTELERİNDE KAPASİTE DEĞERLENDİRMESİ VE PLANLAMASI: 3. BASAMAK HASTANELER İÇİN SİMÜLASYON MODELLEMESİ

Sağlık sistemleri, birbiriyle karmaşık yollarla etkileşime giren çok sayıda paydaşı içeren insan temelli sistemlerdir. Sağlık sistemlerinin stokastik doğası ve girdilerinin, etkinliklerinin ve çıktılarının karmaşık dinamikleri ve etkileşimleri nedeniyle sağlık hizmeti sağlayıcıları, bu karmaşıklığı anlamalarını ve bu şekilde sistem performanslarını geliştirmelerini sağlayan araçlara ihtiyaç duyar. Yoğun bakım üniteleri (YBÜ), kapasite yetersizliği nedeniyle hastaları tedavi edememekte ve bazı durumlarda hastalar, başka hastanelere sevk edilmekte ve hasta bekleme süreleri uzamaktadır. YBÜ gibi kıt bir kaynağın verimli kullanımı ve yönetimi, bir hastanenin sorunsuz çalışması için kritik öneme sahiptir. Kapasite planlaması, yani gelecekteki talep ve kapasite ile ilgili mevcut bilgilere dayanarak optimal yatak konfigürasyonunun belirlenmesi hem kapasite hem de talepteki yüksek belirsizlikler nedeniyle çok zordur. Bu problemin çözümü için çalışmada, yoğun bakım yatak kapasitesi planlamasının karar verme sürecini kolaylaştırmak için simülasyon modeli önerilmektedir. Bu çalışma, Türkiye’de faaliyette bulunan 3. basamak bir üniversite eğitim araştırma hastanesindeki YBÜ’nün kapasite planlamasını geliştirmeye odaklanmaktadır. Çalışmanın amacı, YBÜ’nün kaynaklarını taleple eşleştirerek optimum yatak ihtiyacını belirlemek olarak tanımlanabilir. Çalışmanın sonucunda oluşturulan simülasyon modelleri, hastaların bekleme süreleri ve yatak sayılarına göre değerlendirilerek yoğun bakım kapasitesi hakkında öngörülerde bulunulmuştur. YBÜ’lerin hayati önemi, yönetiminde belirsizlik durumları gözönüne alındığında, farklı bölge ve hastane koşullarında kapasite kararlarının alınmasında bir araç olarak simülasyon yönteminin kullanılması, karar alıcılara kaynak tahsis stratejilerini değerlendirmelerinde yardımcı olabileceği öngörülmektedir.

Anahtar Kelimeler:

Simülasyon, Yoğun Bakım Ünitesi, Kapasite Planlaması, Hasta Akışı

CAPACITY EVALUATION AND PLANNING IN INTENSIVE CARE UNITS: SIMULATION MODELING FOR LEVEL III HOSPITALS

Health systems are human based systems comprising a high number of stakeholders who interact with each other in complex ways. Due to the stochastic nature of health systems and the complex dynamics and interactions of their inputs, processes and outputs; providers of health services require tools tat allow them to comprehend the said complexity and improve system performance. Intensive care units (ICUs) may fall short in treating patients due to insufficient capacity and patients may be transferred to other hospitals under certain circumstances, and waiting times can get longer. Efficient use and management of a scarce resource such as the ICU is of critical importance for trouble-free operation of a hospital. Capacity planning, in other words, determination of optical bed configuration based on current knowledge of future demand and capacity, is very difficult due to high uncertainty in both bed capacity and demand. The paper at hand proposes a simulation model to allow an easier decision-making process in the planning of bed capacity in ICU. The study focuses on improving the capacity planning of a level III university hospital in Turkey that specializes in education and research. The objective of the study is to determine optimal bed requirement by matching the resources of the ICU with demand. We provide forecasts of ICU capacity by evaluating the simulation models based on patient waiting times and bed quantity. Considered in the context of the vital importance of intensive care units and the uncertainties in their management, it is thought that the use of simulation modeling in the making of capacity decisions can prove useful for decision makers in assessing their resource allocation strategies under different regional and hospital conditions.

Keywords:

Simulation, Intensive Care Unit, Capacity Planning, Patient Flow,

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