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This article presents a method by which performances at an emergency department (ED) in a large hospital in Iran could be improved, where the long waiting times and unbalanced utilization create problems for patients and ED staff. This method firstly simulates patient flow in the ED and finds bottlenecks that cause inefficiency in ED performance. In the simulation model, patient arrival is assumed to be non-homogenous and the operation of medical tests such as MRI, CT scan, pathology testing, laboratory testing, ultrasonography, and radiology are detailed and virtual queues of patients' specimens are considered separately from patient queues. Based on the simulation reports of the current situation and target criteria, what-if scenarios were used to design scenarios that could improve ED performance. This method used the data envelopment method (DEA) to determine efficient scenarios, analytic hierarchy process (AHP) to specify the weight of each criterion, the Delphi method to specify suitable utilization rates for various resources, and the extended Vlsekriterijumska Optimizacija I KOmpromisno Resenje (VIKOR) method to compare data on 95% confidence intervals from efficient scenarios and to rank scenarios by considering conflicting criteria. Implementing the first scenario in the ranking would reduce acute patients' overall waiting time by approximately 5%, and it doesn't require any additional investments.

Improving performances of the emergency department using discrete event simulation, DEA and the MADM methods