University hospital

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.

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.

  対象Board, 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.

  対象New 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.

  対象Nursing 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.

  対象Corporate 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.

  対象Board, medical controlling, building and site planning

What is shown – why – for whom

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.

All processes in the model

What you can change

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.

• 

  Health insurer

  A statutory health insurer as a walkable model: how a wheelchair application moves from quote to decision, when the medical service steps in and where deadlines get tight.

• 

  Pharmaceutical company

  A pharmaceutical plant as a walkable model: follow a batch from the cleanroom to certification by the qualified person and see where the four weeks go.

• 

  University

  A university as a walkable model: see how an exam turns into a recorded grade, how a professorship is filled and where the academic year creates peaks.

• 

  Police authority

  A city police authority as a walkable model: what happens after an emergency call, how many patrols it takes and what shortens the time to arrival.

• 

  Hotel

  A city and conference hotel as a walkable model: how a room gets from check-out at 11 to check-in at 3 pm and where cleaning, inspection or front desk run out of time.

• 

  City administration

  A large city's administration as a walkable model: see how a building application moves through the departments, how council and committees meet and where people queue at the counter.

• 

  Construction group

  A construction and infrastructure group as a walkable model: see how a viaduct is built section by section and where frost, inspections and variations cost time.

• 

  Online retail

  An order from click to doorstep as a walkable model: payment check, warehouse, packing, trucks, sortation and delivery in a running simulation.