MODELLING AND SIMULATION OF A PRE-HOSPITAL EMERGENCY CARE NETWORK USING TIMED COLOURED PETRI NETS


MODELLING AND SIMULATION OF A PRE-HOSPITAL EMERGENCY CARE NETWORK USING TIMED COLOURED PETRI NETS

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ABSTRACT

            Pre-hospital emergency network serves as a major gateway to the Accident and Emergency (AE) department of  hospitals which is affected by overcrowding, and majority of projects studying pre-hospital emergency care network  deal only with ambulance or fireman localisation as a means of addressing the problems confronting the Accident and Emergency (AE) department. However, this research work studied in detail the patient flow through the pre-hospital emergency care network. Taking into account not only fireman and private ambulances localisation, but also the other services performed in this network such as Emergency call service the service of the Emergency response team using Timed Coloured Petri Nets.

            In developing a Timed Coloured Petri Nets (TCPN) model for a pre-hospital emergency care network, the emergency service of the State of Osun (O’ambulance) was used as a case study. The developed pre-hospital emergency care network (TCPN) model consists of five sub modules. Arrival sub module modelled the arrival of emergency calls with different health cases. Sort call sub module modelled the call desk and how emergency calls are received by the available call desk agent (perm). Perm Decision sub-module modelled the decision of call desk agent (perm) based on the emergency cases. Rescue team (RT) Decision sub module modelled the decision and intervention of Rescue team. While the Rescue-to-hospital sub-module modelled the transportation of victims to hospital.  The developed TCPN model was simulated using CPN tools. The validation of the developed TCPN model was explored by carrying out the statistical analysis between the simulated and the observed emergency call cases under study.

            The simulation results of the developed TCPN model revealed the number of emergency cases that require immediate and urgent response as 2, 6 and 19 while those that require no immediate response as 8, 22, 64 for the first, second and third simulations respectively. Revealing that some emergency calls require no immediate response and patients do not need to be taken to the hospital. Statistically, there were no significant difference between the simulated and the observed number of emergency cases that require immediate and urgent response.

 

Conclusively, this research work has been able to develop a TCPN model for studying a pre-hospital emergency care network. Also, the developed Timed Coloured Petri Nets model, through its simulation, could help in predicting the number of patients that do not need to be taken to the emergency department hence, reducing overcrowding in  hospitals.


 

TABLE OF CONTENTS

Title page                                                                                                                                      i

Certification                                                                                                                                ii

Dedication                                                                                                                                  iii

Acknowledgements                                                                                                                    iv

Abstract                                                                                                                                       v

Table of  Contents                                                                                                                      vi

List of Figures                                                                                                                             x

List of Tables                                                                                                                              ix

CHAPTER ONE                                                                                                                 

INTRODUCTION                                                                                                                

1.1       General  Overview                                                                                                          1

1.2       Statement of  the Problem                                                                                               2

1.3       Aim and Objectives                                                                                                         3

1.4       Significance of the  Study                                                                                               3

1.5       Scope of  the  Study                                                                                                        3

1.6       Methodology                                                                                                                   4

CHAPTER TWO

LITERATURE REVIEW                                                                                                           5

2.1       Accident and  Emergency                                                                                               5

2.2       Accident and Emergency cases in Nigeria                                                                      5

2.3       Classification of Hospital                                                                                                6

2.3.1    Clinic                                                                                                                   6

2.3.2    Primary Health Care Centre                                                                                7

2.3.3    Comprehensive Health Care Centre (Medical Centre)                                        7

2.3.4    Secondary Health Care Centre(General Hospital)                                              7

2.3.5    Tertiary Health Care Centre(Special Hospital)                                                    8

2.3.6    Teaching Hospital                                                                                                8

2.4       Pre-hospital Emergency Service                                                                                      9

2.5       Accident and Emergency Department/Unit                                                                  10

2.6       Modelling Pre-Hospital Emergency Care flow                                                             11

2.7       Nature and Scope of Operation                                                                                    14

2.8       Pre-Hospital Emergency Record                                                                                   14

2.9       Pre-Hospital Emergency Patient Care Flow                                                                  18

2.9.1    Arrival  at the Scene                                                                                           18

2.9.2    Patient’s Safety                                                                                                            18

2.9.3    Initial Scene Assessment                                                                                    19

2.9.4    Communication                                                                                                 19

2.9.5    Triage                                                                                                                 19

2.9.6    Access to Patient                                                                                               19

2.9.7    Packaging and Evacuation                                                                                20

2.9.8    Transport                                                                                                           20

2.9.9    Receiving Hospital                                                                                            20

2.10.    Emergency  Triage                                                                                                         21

2.10.1  Benefits of  Triage                                                                                             21

2.10.2  Triage and the Colour Codes(The Health Traffic Light)                                  22

2.11     Challenges of Accident and Emergency Unit                                                                        22

2.11.1  Overcrowding                                                                                                   23

2.11.2 Management of Queues                                                                                    24

2.11.3  Patient Waiting Times                                                                                       25

2.12     Petri Net Concepts                                                                                                        26

2.13     Classes of Petri Nets                                                                                                     28

2.13.1  Classification of Petri Nets                                                                               29

2.13.2  High Level Petri Nets                                                                                        29

2.13.2.1 Extension with Colours                                                                                   29

2.14     Properties of Petri Nets                                                                                                 29

2.14.1  Behavioural Properties                                                                                      30

2.14.2  Structural Properties                                                                                          32

2.15     Modelling with Petri nets                                                                                              32

2.15.1  Parallel Processes                                                                                               33

2.15.2  Mutual Exclusion                                                                                              34

2.15.3  Dataflow Computation                                                                                     34

2.16     Transition Enabling and Firing Rules                                                                            35

CHAPTER THREE

RESERCH METHODOLOGY                                                                                               38

3.1       The Modelling Approach                                                                                              38

3.2       The Developed Pre-Hospital System Model Marking Analysis                                    39

3.3       The Case Study                                                                                                             40

3.3.1    The Call Centre                                                                                                 41

3.3.2    The Rescue Team                                                                                              41

3.3.3    O’ambulance Management                                                                                41

3.3.4    Fire Department                                                                                                42

3.4       Model of the developed Petri Net                                                                                45

3.5       Declarations used for the Model                                                                                   45

3.6       Data Collection                                                                                                             49

3.7       Data Analysis                                                                                                                49

3.8       The Developed Petri Net Model of Pre-hospital Emergency Care Network                52

3.8.1    Arrival                                                                                                               52

3.8.2    Sort Calls                                                                                                           52

3.8.3    Perm Decision                                                                                                   53

3.8.4    Rescue Team Decision                                                                                      53

3.9       Validation of the developed TCPN Model                                                                   53

CHAPTER FOUR

RESULTS AND DISCUSSION                                                                                                 

4.1       The Developed Petri Net Model Of Pre-Hospital Emergency                                      60

            Care Network                                                                                                               

4.2       Simulation Result of the Developed Timed Coloured Petri Net Model of Pre-              

            Hospital Emergency Care Network                                                                              60

4.3       Validation Result of the developed TCPN Model of Pre-hospital Emergency Care      

            Network                                                                                                                        62

CHAPTER FIVE             

CONCLUSION AND RECOMMENDATION                                                                      66

5.1       Conclusion                                                                                                                     66

5.3       Contributions to Knowledge                                                                                         66

5.3       Recommendation                                                                                                          66

            References                                                                                                                     67

            Appendix        O’Ambulance Services, State of Osun, Nigeria.                                  70

 

LIST OF FIGURES

Figure                                                                                                                                   Pages

2.1       Pre Hospital Emergency Care flow                                                                               18

2.2       Petrinet basic elements                                                                                                  28

2.3       Compact representation of a Petrinet                                                                            28

2.4       Petrinet representing parallel activities                                                                          33

2.5       Mutual Exclusion                                                                                                          34

2.6       Dataflow example                                                                                                         35

2.7       Mathematical and Graphical representation of Petrinet element                                  36

3.1       Flow diagram of O’ambulance Emergency care flow                                                   43

3.2       Flow diagram of O’ambulance rescue team  actions                                                     44

3.3       Screenshot for the declaration for the Developed TCPN Model                                  46

3.4       Screenshot of arrival of rescue team                                                                             55

3.5      Screenshot of Sort calls                                                                                                  56

3.6       Screenshot of Perm decision                                                                                         57

3.7       Screenshot of Rescue Team decision                                                                            58

3.8       Screenshot of Accident and Emergency at hospital                                                     59

4.1       Screenshot of Rescue Team decision                                                                            61

4.2       Graph showing the variation in the two emergency cases                                            64

           

 

 

 

 

 

LIST OF TABLES

Tables                                                                                                                                   Pages

2.1       Detail of Accident and Emergency Record Modules 1                                               16

2.2       Detail of Accident and Emergency Record Modules 11                                             17

3.1       Place Name, Type and their Functions                                                                         47

3.2       Transition Name and their Actions                                                                              48

3.3       O’Ambulance Emergency cases in November 2013                                                    50

3.2       O’Ambulance Emergency cases (per week)   in November 2013                                 51

4.1       Simulation Result of the Developed pre-emergency care network model                    63

4.2       Validation of the variation in the emergency cases of the Developed TCPN Model.  65


CHAPTER ONE

INTRODUCTION

1.1                  General Overview

               The accident and emergency (AE) unit is one of the most sensitive and crucial departments in hospitals. Patients with severe conditions are admitted and treated without prior appointment and this department operate 24 hours a day, seven days a week. AE unit reason for being crucial can be accrued to the fact that it provides treatment to patients whose condition needs serious and immediate attention.  The sensitivity of the unit is as a result of the fast and important decisions that needed to be made by the medical practitioners, who are to attend to numerous patients with diverse medical conditions ranging from accidents like food poisoning, fire burn  and other emergency cases.

As a result of the nature of accident and emergency (AE) unit, it suffers from a lot of complexities, overcrowding and anomalies which must be paid attention to in order to deliver high quality care. AE unit overcrowding is due to many complex reasons that can be related to the pre-hospital emergency care network, the ED itself, or to the exit of the ED. Many studies tried to analyse this problem. Some of them deal with the improvement of the ED system (Yeh and Lin 2007). Other ones focus on the post-hospital care, especially the problem of allocation planning of hospital bed resources (Wang et al., 2007). Some other researchers are interested in studying the pre-hospital network emergency care which sorts out patient flow. In fact, a bad organization of this pre-hospital network may be an important cause of the ED overcrowding (Cotard 2002; La Cour des Comptes 2007).The majority of projects studying this network deal especially with ambulance or fireman localisation (Takeda et al. 2007). In this research work, a detailed study of the patient flow through the pre-hospital emergency care network was considered.  Taking into account not only fireman and private ambulances localisation, but also the other services performed in this network such as Emergency call service

A model of the actual processes of pre-hospital care network was developed, since modelling plays a key role in complex system development. Modelling is the use of a simple, but explicit form to represent discrete event system. Timed Coloured Petri Nets (TCPN) was chosen to simulate the developed model.

1.2    Statement of the Problem

         In hospital, problems occur due to  congestion and complexity in accident and emergency unit. A lot of anomalies such as overcrowding, long waiting time, and insufficient staffs coupled with wastage of available resources  affect the treatment of patients and the overall clinical processes of the accident and emergency department (Joumana et al., 2011).

        The previous area of research work studying pre-hospital emergency care network deal only with ambulance or fireman localisation as a means of addressing the problems confronting the Accident and Emergency (AE) department. However, this research work studied in detail the patient flow through the pre-hospital emergency care network. Taking into account not only fireman and private ambulances localisation, but also the other services performed in this network such as Emergency call service and the service of the Emergency response team. Timed Coloured petri nets (TCPN) was used to model the care flow in pre-hospital network.

 

1.3       Aim and Objectives

           The aim of this research work is to model and simulate a  pre-hospital emergency care network using Timed Coloured Petri Nets.

 The specific objectives are to:

i.                    develop a Timed Coloured Petri Net (TCPN) model for a pre-hospital emergency care       network using Osun State Emergency Service, Osogbo, as a case study;

ii.                  simulate the developed TCPN model using CPN tools;

iii.                validate the developed TCPN model on the basis of the simulated and the measured         emergency response rate.

 

1.4       Significance of the Study

 In this field of study, a concept is not studied directly but through a model of the system. By the manipulation of the representation, it is hoped that new knowledge about the modelled system can be obtained without danger, cost or inconvenience of manipulating the real system itself. Thus, the developed Timed Coloured Petri Nets model through its simulation could help in studying and improving pre hospital emergency  care service  and  hence, reduces overcrowding in Emergency department in hospitals. 

 

1.5       Scope of the Study

In this research work,  Osun State Emergency Service, was considered, having thirty ambulance vehicle distributed across the thirty Local Government of the State, with four ambulance vehicle stationed in strategic places  in the State Capital, Osogbo.  Timed Coloured Petri Nets was mainly used to model the  pre-hospital emergency care network with the use of CPN tools to simulate the model.  Validating the developed TCPN model on the basis of the simulated and the measured emergency response rate

1.6       Methodology

            The methods of the study employed in this research work are as follows:

i.                    Establishment of a theoretical foundation for the research through a sound literature          review.

ii.                  Identification of pre-hospital emergency care network process.

iii.                Discussion and Collection of record from pre-hospital emergency management.

iv.                Development of a model for the process.

v.                  The developed model was simulated three times using Timed Coloured Petri Nets                         tools.

MODELLING AND SIMULATION OF A PRE-HOSPITAL EMERGENCY CARE NETWORK USING TIMED COLOURED PETRI NETS

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  • TYPE : PROJECT MATERIAL
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Pre-hospital emergency network serves as a major gateway to the Accident and Emergency (AE) department of hospitals which is affected by overcrowding, and majority of projects studying pre-hospital emergency care network deal only with ambulance or fireman localisation as a means of addressing the problems confronting the Accident and Emergency (AE) department. However, this research work studied in detail the patient flow through the pre-hospital emergency care network. Taking into account not only fireman and private ambulances localisation, but also the other services performed in this network such as Emergency call service the service of the Emergency response team using Timed Coloured Petri Nets. .. nursing project topics

MODELLING AND SIMULATION OF A PRE-HOSPITAL EMERGENCY CARE NETWORK USING TIMED COLOURED PETRI NETS