Hospital Selection in Emergency Medical Services: A Discrete Event Simulation Approach to Test Different Policies

The present study aims to develop a simulation model to test and compare different hospital selection policies with the purpose of improving Emergency Medical Service (EMS) systems management. The literature analysis revealed that the assignment of patients to Emergency Departments (EDs) can be based on different policies, even if the predominant one is proximity (i.e. minimization of the distance between the emergency request location and the ED). Indeed, current studies are mainly ambulance-driven with a focus on the EMS phases related to ambulance service, thus overlooking ED-related issues that are seen as part of a separate process. The purpose of this research is to show the benefits of making the hospital selection decision also considering information related to the ED case mix, the expected service throughput times, and the ED operational capacity. To this end, a Discrete Event Simulation model on was developed and implemented in AnyLogic to test different assignment policies. The best criterion for assigning patients to EDs resulted to be the minimization of the Time To Provider (TTP), considered as the time from the beginning of the ambulance journey to the beginning of the clinical evaluation in ED. Indeed, this criterion enables to significantly reduce service throughput times and overcrowding situations in the EDs. The findings of this research could support decision-makers in improving EMS performances by introducing more effective policies for hospital selection problem.