Simulation-Based Models of Emergency Departments: Operational, Tactical, and Strategic Staffing: Operational, tactical, and strategic staffing

Sergey Zeltyn, Yariv N. Marmor, Avishai Mandelbaum, Boaz Carmeli, Ohad Greenshpan, Yossi Mesika, Sergev Wasserkrug, Pnina Vortman, Avraham Shtub, Tirza Lauterman, Dagan Schwartz, Kobi Moskovitch, Sara Tzafrir, Fuad Basis

Research output: Contribution to journalArticlepeer-review

66 Scopus citations


The Emergency Department (ED) of a modern hospitalisahighly complex system that gives rise to numerous managerial challenges. It spans the full spectrum of operational, clinical, and financial perspectives, over varying horizons: operational - a few hours or days ahead; tactical - weeks or a few months ahead; and strategic, which involves planning on monthly and yearly scales. Simulation offers a natural framework within which to address these challenges, as realistic ED models are typically intractable analytically. We apply a general and flexible ED simulator to address several significant problems that arose in a large Israeli hospital. The article focuses mainly, but not exclusively, on workforce staffing problems over these time horizons. First, we demonstrate that our simulation model can support real-time control, which enables short-term prediction and operational planning (physician and nurse staffing) for several hours or days ahead. To this end, we present a novel simulation-based technique that implements the concept of offered-load and discover that it performs better than a common alternative. Then we evaluate ED staff scheduling that adjusts for midterm changes (tactical horizon, several weeks or months ahead). Finally, we analyze the design and staffing problems that arose from physical relocation of the ED (strategic yearly horizon). Application of the simulation-based approach led to the implementation of our design and staffing recommendations.

Original languageEnglish GB
Article number24
JournalACM Transactions on Modeling and Computer Simulation
Issue number4
StatePublished - Aug 2011


  • Emergency departments
  • offered-load
  • operational planning
  • tactical planning
  • strategic planning
  • simulation and modeling
  • health care
  • queues
  • queuing theory


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