Integração do planejamento sistemático de layout, do pensamento enxuto e da simulação a eventos discretos para o projeto do layout de um pronto atendimento hospitalar

Abstract

The importance of the healthcare facilities is unquestionable and, in times of the Covid- 19 pandemic and its uncertainties, the application of Production Engineering knowledge in studies that can cause improvements and better understanding about this area is even more crucial. A study is carried out on the layout design of hospital department from the perspective of the integration of three tools: the Systematic Layout Planning, Lean and Discrete Events Simulation. The first one, used for assist problems in hospital departments, presents a script for the layout project or even its modification. The second brings Lean Thinking and its concepts in healthcare. And the last one, allows multiple health-related analyzes to be carried out, without real risk and at low cost. The research proposes to build a script, based on this integration, where each one of its stages is described and presents how they were used for the layout design of the emergency care of a philanthropic hospital, in the southern region of Minas Gerais. With the use of the systematic proposal for the object of study, it is intended to find results that help in making a safer decision in relation to physical changes. Thus, in the final stage of its application, layout alternatives were tested for three levels of possible demands for the future. The parameters of interest were defined: the lead time, the waiting time and the number of visits. It was found that, depending on the variation in demand, it possible to add processes or change some activity so the workload can be divide, waste of movement and waiting reduced and use better the human resources. The displacement of the patient without accompaniment allows to minimize the waste of movement of the doctor. The insertion of triage in the current layout is not advantageous, since the number of visits goes from an average of 25 to 28 patients per day, with large increases in the values of the parameters of interest. The scenario with the highest capacity for daily care, when compared to the previous layout, has a small increase in parameters that is justified by being able to attend an average of 30 more patients per day. The guide was successfully used to study the proposals for physical changes in the department of interest, it allows to assess the current status of the service and what are the possible changes in layout and its implications, as well as when they should be made.