The first simulation models, which we tailor-made for medical facilities, were intended for hospitals in Znojmo and Vsetín. Among the most interesting were, for example, the Benešov project and work for the University Hospital Hradec Králové. Over the last 20 years, DYNAMIC FUTURE, in co-operation with the Zlín company SALSO, has implemented dozens of smaller and larger events, the aim of which was to facilitate the work of doctors, while bringing patients comfort corresponding to the 21st century.

Dynamic model of operating theatres in the Znojmo Hospital

“In Znojmo, in 2008, we did simulations for operating theatres for the first time. When we arrived there and sat with the director of the hospital, I did not forgive myself for the sentence: I would not want to be sick here – I would be afraid that you would get lost with me on the way to the operating theatre,” recalls Petr Jalůvka, Managing Director of DYNAMIC FUTURE.

According to him, it was crucial that the director was very open, and approachable to change his view of the processes in the hospital. The aim of the study was to identify problem areas in terms of options for planning operations, to propose changes to improve the use of operating rooms, operating teams, and special surgical equipment, as well as to examine future layout options.

The Central Operating Tract (COT) was used by the surgery, orthopaedics, gynaecology and obstetrics, ORL (ear, nose, & throat dept.), urology, ophthalmology, internal medicine, paediatrics, and ARO (Anaesthesiology and Resuscitation) departments. There were a total of 6 operating rooms and one room for small procedures. It was necessary to work with data such as types and lengths of anaesthesia, number of operations per day, staffing, surgical instruments, patient movement, and the like.

“Based on the outputs of the simulations, we came to the conclusion that the capacity of the operating theatres in the planned condition is sufficient, and it is possible to increase it by more than twice the current values. This value was of course theoretical, and was based on the assumption that the increase in operations corresponds to the time distribution in 2008, the structure of operations will be the same, and the ratio of acute operations will remain the same,” says P. Jalůvka.

DYNAMIC FUTURE designed a new arrangement of operating theatres, which allowed an increase in their capacity, the establishment of a septic room, the improvement of the technical background of the staff, and the separation of clean and unclean spaces. The final report also included a description of COT’s weaknesses, namely the many handling corridors, the lack of a central warehouse with a larger capacity, the storage of emergency supplies in too many places, and the fragmentation of the technical background of the staff.

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Simulation of the supply of operating theatres with sterilized and medical supplies in the new operating pavilion of the University Hospital Hradec Králové

The hospital planned to build a new operating pavilion with a capacity of 21 operating rooms, including central sterilization. The aim of the DYNAMIC FUTURE study was to verify the settings of all of the processes related to the planned extension and, among other things, to find out whether it was

necessary to set aside a separate room for acute operations, how many paramedics are needed to transport patients during the day, how many boards for operated patients in the rooms circulation, what will be the use of operating theatres, or whether 24 in-patient beds would be enough. This was 2016.

“We described the planning of the operational programme, the flow of material to the operating theatres, and proposed its management. Thanks to a virtual operational plan, validated with historical data, we were able to analyze planned and acute interventions. The simulation allowed us to realize something interesting – a so-called ‘virtual operating room’,” says Petr Jalůvka.

The dynamic simulation has verified that it is not necessary to set aside an operating theatre for acute operations, due to the sufficient capacity of the operating theatres. On the contrary, it is advantageous not to set it up, because there is a more efficient use of both spatial and technological capacity and, above all, human resources. In the case of reserving one operating theatre for acute procedures, there would still be a need to move acute patients to other rooms, and vice versa, in the case of a shortage of acute patients, these resources would be unused. By creating a so-called ‘virtual acute operating theatre’, on the other hand, there was a better use of capacity, and the ability to respond more quickly to the current need for capacity for acute operations, because every 20-30 minutes in a row a “capacity window” opens for these services in the next operating theatre.

In addition, DYNAMIC FUTURE submitted to the contracting authority a draft of operation plans with an average occupancy of 88% of the operating theatres, a proposal for the establishment of 24 in-patient beds, a proposal for the number of paramedics, and, for example, the configuration of continuous washing and sterilization.

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Optimization of central admission of patients in the outpatient clinics of Rudolf and Stefanie Benešov Hospital

A project from 2016, focused on the optimal arrangement of internal pavilion ambulances, including central admissions, worked with three variants – central admissions in the premises of existing out-patients departments (and optimization of their location), along with extension to the internal pavilion in two versions requiring relocation of ICU internal to new premises, and optimization of new central admissions location of in-patient departments.

“We projected a reduction in patient admission time, increasing the quality of the patient admission process, increasing the use of workplaces and staff in the patient admission process, designing an admission scenario, implementing patient analysis of the admission process to define potential savings and define project areas,” says Jan Šlajer, Managing Director of DYNAMIC FUTURE.

According to him, it was interesting how they collected the necessary data. Students were sent “to sit” directly at the hospital central admissions, measuring how and when individual patients came. Within a few days, they gained information about the passage of people and the distribution of the week and individual hours. It should be added that the primary intern was extremely optimistic.

“If you imagine that you have one or two nurses on the central admissions reception, who count people, count how many people come per day, and make an average, then it turns out that two employees can easily handle the admissions of patients. But when you make a graph of how people really come, you suddenly see that sometimes sixty patients are waiting for admission, and other times, the waiting rooms are empty,” describes Jan Šlajer, adding that the simulation beautifully shows the possibilities of using the clinics and setting the capacity of the waiting rooms.

The final report of the project states: “Although the sponsor’s staff moves daily around the outpatient clinics of the internal medicine and neurology departments, it was also a surprise for them to show the declining number of patients in the internal medicine department versus the growing trend in neurology outpatient clinics. For this reason, too, we have developed an alternative to changing the outpatient clinic of the internal medicine department to a central admissions reception with an expanded number of connected outpatient clinics of the internal medicine and neurology departments.”

The output of the project was the design of a central admissions reception and a central waiting room in the middle of the internal department, near the sanitary facilities. At the same time, it was recommended to equip the waiting room with vending machines for coffee, tea, and cold drinks, which will improve the comfort that the central internal and neurological clinics will provide.

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The problem is the finances and pavilion solutions of domestic hospitals

“When it comes to dynamic simulations for hospitals, we build on the very rich experience of our partner, Lanner Group, who has a number of projects for medical facilities in France and America, and has given us access to them,” says Jan Šlajer.

In his experience, domestic hospitals still face many difficulties where the use of simulations does not meet the specific demands. They are limited by low budgets, complicated tenders, bureaucracy, or myopia of their management.

“For example: we designed specific technologies for the hospital to streamline internal processes. The construction of the building in which they were to operate was planned for 5 years, the hospital wanted to fix the type and price of the equipment with the technology supplier, which is an insurmountable situation for every company. The development moves forwards at a fast pace, and in 5 years, it will produce completely different products in a different quality,” says J. Šlajer.

The way our hospitals are built is also a problem. Inspiration from abroad is therefore sometimes, so to speak, impossible.

“In Western Europe, they try to manipulate with the patient as little as possible, with all operations being performed in one building. In the Czech Republic, however, we have pavilion-type hospitals. There are different technologies in each building, and when it is necessary to treat a patient with several problems, the medical staff will spend a lot of time transporting him/her,” Petr Jalůvka says, as another example.

In his opinion, even newly emerging hospital complexes do not always look at the efficiency of processes. Architects often proceed with hospital designs the same way as they have always been designed.

“Doctors should heal people and save lives. Hospitals must prepare the conditions for them to work efficiently, without unnecessary tasks and stress. Patients should feel safe in such facilities, and spend only as much time as is absolutely necessary. Describing all of the processes and approaching their optimization brings benefits for both the healthcare professionals and the clients of any healthcare facility,” concludes Jan Šlajer.