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