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Simulazione · Minimal Organization · City, health, knowledge, construction

University hospital

A university hospital as a walkable model: see where an emergency patient's time goes and why the strongest lever sits on the wards.

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KLINIKUM WESTERBRÜCK is invented; triage mix, admission rate and length of stay are assumptions. With your hospital's data the model shows what is scattered today – such as actual arrivals per hour and triage level, or discharge times per ward.

This hospital patient flow simulation follows the emergency department of KLINIKUM WESTERBRÜCK, a fictional university hospital. Emergencies, operations and research share beds, theatres and labs – around the clock. Without a staffed bed available, a patient stays in the ED.

The path of an emergency: registration, five-level triage, doctor contact, lab and CT in parallel, results and decision, then bed search, ward, discharge planning and billing with the health insurer. As its target the model uses the UK benchmark of under four hours in the ED; Germany has no statutory target time for this.

With ‘Discharge by 11 am’, beds become available earlier in the day and waiting in the ED drops. If nurses are missing, minimum staffing rules force beds to close. The model shows processes, not medical recommendations. The page is for the board, nursing and medical directors, bed management and education.

An emergency is treated

  1. 01

    ED registration: A patient arrives at the emergency department – walking in or by ambulance. Registration records the details.

  2. 02

    Triage: Triage using the Manchester Triage System: five levels with target times until seeing a doctor.

  3. 03

    Resuscitation room: A team treats the life-threatening case immediately.

  4. 04

    Acute area: doctor: A doctor examines and orders lab tests and imaging.

  5. 05

    Blood goes to the lab while a CT or X-ray is taken.

  6. 06

    Central lab: The central lab measures blood values, e.g. a cardiac marker.

  7. 07

    CT and X-ray: Radiology takes a CT or X-ray.

  8. 08

    Both results are in.

  9. 09

    Findings and decision: With the results the team decides: admit, straight to the catheter lab, or home.

  10. 10

    Fast track: Minor cases are treated quickly in a separate area.

  11. 11

    Again: CT and X-ray: An X-ray checks e.g. for a fracture.

  12. 12

    Cardiac catheter: Heart attack: the blocked vessel is reopened in the catheter lab.

  13. 13

    Bed allocation: The bed management centre looks for a free bed in the right clinic.

  14. 14

    Surgical beds: Surgical ward: nursing, rounds, treatment.

  15. 15

    Medical beds: Medical ward: nursing, rounds, treatment.

  16. 16

    Neurology beds: Neurology ward, e.g. after a stroke.

  17. 17

    ICU beds: Intensive care: monitored around the clock, often ventilated.

  18. 18

    Again: Bed allocation: Bed management finds a bed on a normal ward.

  19. 19

    Discharge management: Discharge management plans the transition: medication, discharge letter, rehab or care.

  20. 20

    Handover to rehab or care home: A rehabilitation clinic or care home takes over.

A site at work

01

A site at work

6 buildings, 22 departments, about 7,400 staff: in the evening light golden arcs show who reports to whom.

Every floor opened up

02

Every floor opened up

Every building can be opened, floor by floor – right into single rooms such as ‘Executive board’, with workplaces and people at work.

What is shown – why – for whom

Cosa viene mostrato Perché Per chi
Diagram ‘What each control does’: discharge by 11 am, staffed beds, doctors, triage Perchéshows that the strongest lever lies on the wards Per chiBoard, nursing director, medical director
Diagram ‘Where the time goes’ in the ED Perchéseparates treatment from waiting for a bed Per chiED management, bed management
Diagram ‘How a case flows’: resuscitation room, fast track, cath lab, wards Perchéshows the paths of an emergency Per chiEducation, ambulance service
Diagram ‘Where it gets tight’ when nurses are missing Perchéshows closed beds and the backlog Per chiNursing directorate, workforce planning
Diagram ‘Where the site gets tight’: ED and ward tower Perchéshows the load in the buildings Per chiBuilding and site planning
Resources view: patients waiting in the ED Perchémakes visible who is waiting for a bed Per chiED management, the public
Process ‘A planned operation’ next to the emergency Perchéshows the competition for beds and theatres Per chiTheatre management
Who works with whom

03

Who works with whom

‘Emergency department’ with all 10 relations: Quality, hygiene, risk, Patient and bed management, Radiology, Central laboratory, Cardiology, Department of internal medicine and Department of surgery – and outside Ambulance service (fire and rescue station) and Population · patients.

An emergency is treated

04

An emergency is treated

A single case can be followed – step by step, with the waiting time at every station. Target: under 4 hours in the ED (benchmark: UK standard).

Films from the model

  • The tower opens up

    Just before sunset the floors drift apart – ‘Ward tower’ opens up as the camera rises and circles the building until night falls.

  • Who reports to whom, who works with whom

    Blue hour above the site: first the golden arcs of the structure, then the collaboration of the most connected department, finally the whole building.

  • A day in time-lapse

    From ten in the morning to midnight in 26 seconds: the sun moves, the windows light up, at night the data lines glow.

  • Surge and disruption

    In time-lapse: ‘Flu wave’ brings more work, then ‘IT outage’. The control ‘Triage nurses’ set to ‘3’ brings recovery.

  • Seven diagrams

    Calculated live from the model: ‘Who works with whom’, ‘Year, week, day’, ‘Management levels as a staircase’, ‘How a case flows’, ‘What each control does’, ‘What the work depends on’, ‘Where it gets tight’.

  • Using the software

    With the full interface: open a building, a department’s relations, ‘Flu wave’, a control, diagrams with their panel, one case.

Departments in the model

  • Executive board

    Medical director (chair), commercial director, nursing director and the dean of the faculty run the hospital together.

  • Nursing directorate

    Leads nursing professionally across all clinics – across the medical line (matrix).

  • Finance, HR, purchasing

    Plans budget, staff and purchasing; negotiates with insurers.

  • Quality, hygiene, risk

    Monitors infections, incidents and quality indicators and reports to the authorities.

  • IT and hospital information system

    Runs patient record, lab and radiology systems around the clock. Hospitals above a size are critical infrastructure.

  • Patient and bed management

    Admits patients and allocates beds – this decides whether emergencies wait in the ED for a bed.

  • Emergency department

    Accepts every emergency, triages urgency in five levels and treats until discharge or admission.

  • Radiology

    CT, X-ray and MRI for emergencies and planned examinations.

  • Central laboratory

    Analyses blood and samples; a cardiac marker is ready after about one hour (model assumption).

  • Pathology and microbiology

    Examines tissue and pathogens, e.g. for the tumour board.

  • Central theatres and anaesthesia

    Schedules theatres, anaesthetises, operates with the clinics and monitors in recovery.

  • Cardiology

    Treats heart attacks in the catheter lab around the clock.

  • Intensive care

    Cares for the most severe cases; a shortage here cancels planned operations.

  • Department of surgery

    Operates electively and in emergencies; three floors of wards in the tower.

  • Department of internal medicine

    Largest clinic: admits most emergencies.

  • Neurology

    Strokes and other diseases of the nervous system.

  • Discharge management and social services

    Plans the transition home, to rehabilitation or to a care home – required by law.

  • Medical controlling and billing

    Codes diagnoses and procedures and bills insurers.

  • Pharmacy

    Supplies all wards with medicines, including for trials.

  • Sterile services

    Cleans and sterilises instruments for every theatre.

  • Logistics and facilities

    Goods, meals, facilities, energy.

  • Clinical trials and research

    Plans clinical trials, obtains approvals and looks after trial patients.

Flu wave

05

Flu wave

The backlog grows floor by floor – the simulation shows where it gets tight and which control helps.

06

A day in 26 seconds

From ten in the morning to midnight in time-lapse: commuters, moving light, windows switching on – and at night the data lines.

All processes in the model

An emergency is treated

  1. 01ED registration: A patient arrives at the emergency department – walking in or by ambulance. Registration records the details.
  2. 02Triage: Triage using the Manchester Triage System: five levels with target times until seeing a doctor.
  3. 03Resuscitation room: A team treats the life-threatening case immediately.
  4. 04Acute area: doctor: A doctor examines and orders lab tests and imaging.
  5. 05Blood goes to the lab while a CT or X-ray is taken.
  6. 06Central lab: The central lab measures blood values, e.g. a cardiac marker.
  7. 07CT and X-ray: Radiology takes a CT or X-ray.
  8. 08Both results are in.
  9. 09Findings and decision: With the results the team decides: admit, straight to the catheter lab, or home.
  10. 10Fast track: Minor cases are treated quickly in a separate area.
  11. 11Again: CT and X-ray: An X-ray checks e.g. for a fracture.
  12. 12Cardiac catheter: Heart attack: the blocked vessel is reopened in the catheter lab.
  13. 13Bed allocation: The bed management centre looks for a free bed in the right clinic.
  14. 14Surgical beds: Surgical ward: nursing, rounds, treatment.
  15. 15Medical beds: Medical ward: nursing, rounds, treatment.
  16. 16Neurology beds: Neurology ward, e.g. after a stroke.
  17. 17ICU beds: Intensive care: monitored around the clock, often ventilated.
  18. 18Again: Bed allocation: Bed management finds a bed on a normal ward.
  19. 19Discharge management: Discharge management plans the transition: medication, discharge letter, rehab or care.
  20. 20Handover to rehab or care home: A rehabilitation clinic or care home takes over.

A planned operation

  1. 01Referral and appointment: A GP refers the patient for surgery; the clinic gives an appointment.
  2. 02Pre-admission: examination, lab and anaesthesia consultation on one day.
  3. 03Pre-admission clinic: The surgeon examines and informs.
  4. 04Central lab: Blood tests before surgery.
  5. 05Anaesthesia consultation: Anaesthesia consultation.
  6. 06Preparation complete.
  7. 07Indication: For tumours one doctor does not decide alone.
  8. 08Tumour board (weekly): The tumour board meets once a week.
  9. 09Theatre plan (daily 7 am): Theatre management schedules the rooms for the next day.
  10. 10Patient admission: Admission on the morning of surgery.
  11. 11Operation: The operation: surgery and anaesthesia together in the central theatres.
  12. 12Recovery room: Monitoring in recovery.
  13. 13ICU beds: Complication: monitoring in intensive care.
  14. 14Surgical beds: Surgical ward, mobilisation by physiotherapy.
  15. 15Discharge management: Discharge with letter, if needed rehab application.
  16. 16Coding: Coding the operation.
  17. 17Billing the insurer: The insurer pays.
  18. 18Complete.

A clinical trial

  1. 01Trial planning: A clinic has a research question; the trial unit checks feasibility and budget.
  2. 02Authority and ethics committee assess at the same time; contracts run in parallel.
  3. 03Assessment federal authority: The federal authority assesses the trial.
  4. 04Assessment ethics committee: The ethics committee reviews benefit, risk and consent.
  5. 05Contracts and funding: Contracts, insurance, funding.
  6. 06All answers are in.
  7. 07Trial decision: Approved, with conditions, or rejected.
  8. 08Address conditions: The trial unit addresses the conditions.
  9. 09The trial is not approved.
  10. 10Enrol and treat patients: Patients are enrolled and treated in the trial clinic.
  11. 11Analysis and publication: The faculty analyses and publishes.
  12. 12Results published.

How a hospital can use the model

  • Internal communication

    ED, diagnostics, theatres, intensive care, wards, administration and supply in one picture. The model links the backlog in the ED to the beds on the wards – a common starting point for every profession.

    Per chiBoard, nursing and medical directors, communications

  • Onboarding

    New doctors and nurses follow an emergency from the entrance to the ward and see which department takes over when. The eight-step tour explains the controls on the first visit.

    Per chiNew staff in the ED, on the wards and in patient management

  • Training

    Nursing students, medical students and paramedics trigger a flu wave or an IT outage and see how an emergency's paths branch: resuscitation room, fast track, cardiac cath lab, intensive care or general ward.

    Per chiNursing education, medical school, ambulance service

  • Explaining to patients

    ‘Where the time goes’ separates treatment from waiting for a bed. It helps explain to patients, relatives and the public why the ED can take time.

    Per chiCorporate communications, patient representatives, the public

  • Strategic overview

    Discharge by 11 am, staffed beds, doctors in the acute area, triage nurses and planned operations side by side: ‘What each control does’ shows where the strongest lever lies.

    Per chiBoard, medical controlling, building and site planning

Diagrams from the model

07

Diagrams from the model

‘Who works with whom’ as a dome of arcs – one of 14 diagrams calculated live from the same data.

The whole software

08

The whole software

Situation, key figure, time-lapse, six views, controls and disruptions: one click on a department shows its task, location and all relations.

What you can change

Controls

  • ED demand: How many emergencies arrive per day.
  • Triage nurses: Nurses for triage.
  • Doctors in acute area: How many doctors treat at the same time.
  • Staffed beds: Beds only count with nursing staff (minimum staffing rules).
  • Planned operations: More planned operations occupy more beds – also for emergencies.
  • Discharge by 11 am: Earlier discharge frees the bed for the ED in time (model assumption: half a day shorter).

Disruptions

  • IT outage: Six hours on paper: registration, results and bed allocation take more than twice as long.
  • Flu wave: For three days 40 % more emergencies – and nurses fall ill too.
  • Nurses missing: If nurses are missing, beds must be closed under minimum staffing rules – the ED backs up.

What the model gives a hospital

  • 01

    Cause, not symptom

    The queue forms in the ED, the cause sits with the beds. The model shows this link live, ward by ward.

  • 02

    See decisions before making them

    Discharge by 11 am, more staffed beds or fewer planned operations: every control acts at once on the running simulation and its diagrams.

  • 03

    One hospital, three processes

    Emergency, planned surgery and clinical trial run side by side and share beds, theatres and labs, so the competition for resources becomes visible.

  • 04

    Disruptions without patients

    An IT outage, a flu wave or missing nurses can be triggered and observed without affecting anyone.

  • 05

    For boardrooms and lecture halls

    The simulation runs in the browser and can be projected onto large screens. A demo mode shows everything by itself, in a training session or in the lobby.

  • KLINIKUM WESTERBRÜCK am Morgen – tiefe Sonne, lange Schatten, die ersten Pendler auf dem Weg ins Haus.
    KLINIKUM WESTERBRÜCK in the morning – low sun, long shadows, the first commuters on their way in.
  • 6 Häuser, 22 Abteilungen, rund 7.400 Beschäftigte: Im Abendlicht zeigen goldene Bögen, wer an wen berichtet.
    Ward tower in evening light – golden arcs show who reports to whom.
  • Kurz vor acht – Menschen strömen vom Parkplatz und von der Straße in die Häuser.
    Just before eight – people stream from the car park and the street into the buildings.
  • Blaue Stunde – In KLINIKUM WESTERBRÜCK gehen die Fenster an.
    Blue hour – the windows of KLINIKUM WESTERBRÜCK light up.
  • Nachts von oben – Bettenhaus offen, die Datenleitungen leuchten über dem Quartier.
    At night from above – Ward tower opened up, data lines glowing across the site.
  • Bettenhaus aufgeklappt – jede Etage mit Arbeitsplätzen und Menschen.
    Ward tower opened up – every floor with workplaces and people.
  • Dämmerung, Ansicht Leistung – Leuchtringe zeigen, wie ausgelastet jede Abteilung ist.
    Dusk, performance view – rings of light show how busy each department is.
  • Blick in die Etage von Zentrale Notaufnahme – Tischreihen, darüber die Etagen als Lichtumriss.
    Looking into the floor of Emergency department – rows of desks, the floors above as outlines of light.
  • Jedes Haus lässt sich öffnen, Etage für Etage – bis in einzelne Räume wie „Vorstand“, mit Arbeitsplätzen und Menschen bei der Arbeit.
    A room of its own – Executive board.
  • Zentrum für Labor und Forschung offen – alle Geschosse mit Arbeitsplätzen und Menschen.
    Laboratory and research centre opened up – every floor with workplaces and people.
  • Verwaltung – alle Geschosse auf einmal, Ansicht Leistung.
    Administration – all floors at once, performance view.
  • Aufbau in der Dämmerung – goldene Bögen von jeder Etage zu den Häusern, die an sie berichten.
    Structure at dusk – golden arcs from every floor to the buildings reporting to it.
  • „Zentrale Notaufnahme“ mit allen 10 Beziehungen: Qualität, Hygiene, Risiko, Patienten- und Belegungsmanagement, Radiologie, Zentrallabor, Kardiologie, Klinik für Innere Medizin und Chirurgische Klinik – und nach außen Rettungsdienst (Feuer- und Rettungswache) und Bevölkerung · Patientinnen und…
    Collaboration – Emergency department with all 10 relations – to departments, buildings and partners.
  • Datenflüsse bei Nacht – Systeme und Nutzer, verbunden durch leuchtende Leitungen.
    Data flows at night – systems and users linked by glowing lines.
  • Datenflüsse in der Dämmerung – welche Abteilung welches System nutzt.
    Data flows at dusk – which department uses which system.
  • Aufbau über das ganze Quartier – Berichtswege zwischen den Häusern.
    Structure across the whole site – reporting lines between the buildings.
  • Das ganze Netz bei Nacht – Zusammenarbeit im Haus und weit hinaus.
    The whole network at night – collaboration inside and far beyond.
  • Ein einzelner Fall lässt sich verfolgen – Schritt für Schritt, mit der Wartezeit an jeder Station. Ziel: unter 4 Stunden in der Notaufnahme (Vergleich: britischer Standard).
    Every step labelled – name, how many are waiting, utilisation.
  • Ein Fall wird verfolgt – „Ein Notfall wird versorgt“ – Schritt für Schritt durch das Haus.
    Following one case – ‘An emergency is treated’ – step by step through the building.
  • Die Rückstände wachsen Etage für Etage – die Simulation zeigt, wo es eng wird und welcher Regler hilft.
    Flu wave – resources view, the backlog grows floor by floor.
  • Der Griff – Triage-Pflege auf „3“ – ein Lichtblitz zeigt, wo er wirkt.
    The lever – Triage nurses set to ‘3’ – a flash shows where it acts.
  • Frühling bei KLINIKUM WESTERBRÜCK – Bettenhaus offen, Leuchtringe zeigen die Auslastung.
    Spring at KLINIKUM WESTERBRÜCK – Ward tower opened up, rings show the workload.
  • Sommerabend – warmes Licht, lange Schatten, goldene Bögen über dem Platz.
    Summer evening – warm light, long shadows, golden arcs above the square.
  • Herbst – Laub auf den Wegen, Ansicht Leistung.
    Autumn – leaves on the paths, performance view.
  • Winterabend – Schnee auf dem Quartier, Bettenhaus offen und hell, die Zusammenarbeit leuchtet.
    Winter evening – snow on the site, Ward tower open and lit, collaboration glowing.
  • „Wer mit wem arbeitet“ als Kuppel aus Bögen – eines von 14 Schaubildern, die live aus denselben Daten gerechnet werden.
    Diagram ‘Who works with whom’, calculated live from the model.
  • Schaubild „Jahr, Woche, Tag“, live aus dem Modell gerechnet.
    Diagram ‘Year, week, day’, calculated live from the model.
  • Schaubild „Führungsebenen als Treppe“, live aus dem Modell gerechnet.
    Diagram ‘Management levels as a staircase’, calculated live from the model.
  • Schaubild „Wie ein Vorgang fließt“, live aus dem Modell gerechnet.
    Diagram ‘How a case flows’, calculated live from the model.
  • Schaubild „Was welcher Regler bewirkt“, live aus dem Modell gerechnet.
    Diagram ‘What each control does’, calculated live from the model.
  • Schaubild „Woran die Arbeit hängt“, live aus dem Modell gerechnet.
    Diagram ‘What the work depends on’, calculated live from the model.
  • Schaubild „Wo es eng wird“, live aus dem Modell gerechnet.
    Diagram ‘Where it gets tight’, calculated live from the model.
  • Schaubild „Wer führt wen“, live aus dem Modell gerechnet.
    Diagram ‘Who leads whom’, calculated live from the model.
  • Die ganze Software – Lage, Kennzahl, Zeit, Ansichten und die Regler unten.
    The whole software – situation, key figure, time, views and the controls below.
  • Bettenhaus gewählt – Etagenliste rechts, die Etagen schweben auseinander.
    Ward tower selected – floor list on the right, the floors drift apart.
  • Lage, Kennzahl, Zeitraffer, sechs Ansichten, Regler und Störungen: Ein Klick auf eine Abteilung zeigt Aufgabe, Ort und alle Beziehungen.
    Emergency department – card with task, location and all relations.
  • Grippewelle ausgelöst – Chronik, Kennzahl und Engpass reagieren.
    Flu wave triggered – timeline, key figure and bottleneck react.
  • Gegensteuern – Triage-Pflege aufgestockt – die Kachel zeigt die Wirkung seit dem Griff.
    Countering – Triage nurses increased – the tile shows the effect since the change.
  • Schaubild „Wie ein Vorgang fließt“ mit Tafel – Befunde in Sätzen.
    Diagram ‘How a case flows’ with its panel – findings in sentences.
  • Schaubild „Wer mit wem arbeitet“ mit Tafel.
    Diagram ‘Who works with whom’ with its panel.
  • Vorgang verfolgen – Schritt, Wartezeit und Zusage auf der Karte.
    Follow a case – step, waiting time and target on the card.
  • Der Rundgang führt in acht Schritten durch die Software.
    The tour leads through the software in eight steps.
  • 36 Organisationen zur Auswahl, jede mit eigenem Bild.
    36 organisations to choose from, each with its own picture.

Your hospital as a model

We fit the model to your ED, your wards and your processes. Talk to us about your questions and your data; we will send you the password for the simulation on request.

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Chiedere informazioni

Minimal Organization: Klinikum

I dati vanno solo a questo sito e servono unicamente a risponderle.

Basis and limits

Fictional university hospital · model based on researched structures and rules · no medical or operational statement about real hospitals

1 case = 1 patient · 1 figure ≈ 30 employees

All volumes, durations, rates and capacities are model assumptions for understanding, not values of a real hospital.

Distribution across triage levels, admission rate and length of stay (mean 4.5 days, national average about 7) are model assumptions.

Documented: five triage levels with target times (MTS), discharge management (§ 39 SGB V), pre-admission treatment (§ 115a SGB V), parallel assessment of trials (Reg. (EU) 536/2014), beds only with nursing staff (PpUGV).

The 4-hour target is a UK standard used as a benchmark; Germany has no statutory target for ED length of stay.

The faculty of medicine is shown outside as a separate legal entity.

Public sources the model is based on:

  • NRW Universitätsklinikum-Verordnung (UKVO)
  • SGB V (§§ 39, 108 ff., 115a, 275)
  • Krankenhausfinanzierungsgesetz
  • Manchester-Triage-System (DocCheck Flexikon)
  • Verordnung (EU) 536/2014 über klinische Prüfungen
  • ESC-Leitlinien akutes Koronarsyndrom
  • Destatis: Krankenhäuser
  • Pflegepersonaluntergrenzen-Verordnung
  • BSI-Kritisverordnung
  • NHS England: 4-hour A&E standard

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KLINIKUM WESTERBRÜCK is invented; triage mix, admission rate and length of stay are assumptions. With your hospital's data the model shows what is scattered today – such as actual arrivals per hour and triage level, or discharge times per ward.