Purpose: This work aims to integrate the concepts generated by a systematic literature review on patient flows in emergency departments (ED) to serve as a basis for developing a generic process model for ED. Design/methodology/approach: A systematic literature review was conducted using PRISMA guidelines, considering Lean Healthcare interventions describing ED patients’ flows. The initial search found 141 articles and 18 were included in the systematic analysis. The literature analysis served as the basis for developing a generic process model for ED. Findings: ED processes have been represented using different notations, such as value stream mapping and workflows. The main alternatives for starting events are arrival by ambulance or walk-in. The Manchester Triage Scale (MTS) was the most common protocol referred to in the literature. The most common end events are admission to a hospital, transfer to other facilities or admission to an ambulatory care system. The literature analysis allowed the development of a generic process model for emergency departments. Nevertheless, considering that several factors influence the process of an emergency department, such as pathologies, infrastructure, available teams and local regulations, modelling alternatives and challenges in each step of the process should be analysed according to the local context. Originality/value: A generic business process model was developed using BPMN that can be used by practitioners and researchers to reduce the effort in the initial stages of design or improvement projects. Moreover, it’s a first step toward the development of generalizable and replicable solutions for emergency departments.

The adoption of healthcare technologies has grown significantly, with real-time location systems (RTLSs) gaining particular attention. Despite decades of research, gaps persist in understanding the current state of the field and its future directions. This scoping review, conducted by PRISMA guidelines, identified 1718 articles retrieved from six databases, from which 83 were included. The findings reveal a dominance of U.S.-based case studies and a lack of systematic literature reviews. While RFID is the most commonly used technology, alternative solutions are emerging, though few studies explore their combined use. The emergency department is the most studied setting, focusing on patient flow. However, case study quality varies, which affects replicability, and literature reviews often fail to justify technological choices adequately. RTLS benefits include improved efficiency, enhanced patient safety, and cost reduction, but challenges such as precision issues and signal interference persist. RTLS also serves as a foundation for digital twins, integrating AI and Industry 4.0 technologies for more sustainable healthcare operations. Technological advancements may shift perceptions of RTLS challenges and benefits, highlighting the need for analysis by technology type and release date. Additionally, current MeSH terms fail to adequately cover healthcare technologies, resulting in the exclusion of relevant studies.

The article analyses studies on the impact of the COVID-19 pandemic on outpatient services in a large hospital, aiming to provide insights for resource management amidst disruptive events. The objectives include identifying challenges and proposing solutions to optimize service delivery and address spatial constraints using discrete-event simulation. Utilizing a case study approach, the research employs simulation as a key methodology to analyse outpatient service scenarios. Scenarios are generated by combining different probabilities of patient return to check-in with various team parameterizations. The researchers analysed historical data and key performance indicators from the simulation. The study focuses on a collaborative approach with the hospital team to ensure the relevance and applicability of proposed solutions. The research identifies bottlenecks induced by social distancing measures, particularly in patient reception and check-in areas. Uneven service distribution throughout the day leads to a misallocation of resources and reduction of available physical space. Telemedicine emerges as a significant response, effectively addressing both service optimization and physicians’ workload despite spatial constraints. Additionally, the study underscores the role of simulation in crisis decision-making for hospital operations management. Practical applications emanating from the study emphasize the need for healthcare institutions to adopt adaptable strategies and leverage simulation tools for effective resource management during disruptive events. Hospital administrators can draw insights to inform resource reallocation and workflow optimization, with a focus on negotiating flexible scheduling and exploring telemedicine to enhance service delivery.

Over the last decades, there has been a growing demand for healthcare services, driven by increased life expectancy, population ageing and the prevalence of chronic diseases. In this context, there is an increasing need to make hospital systems more robust and efficient. To achieve this, hospital managers have increasingly adopted Lean methodologies, focusing primarily on identifying and eliminating waste, making operations and processes more efficient. The application of these methodologies in the healthcare sector is known as Lean Healthcare. Research in this area has gained growing interest since the late 20th century, resulting in a clear enhancement of hospital system sustainability and service quality. However, a significant gap has been identified regarding the observation of processes and the implementation of concrete tools in hospital units, which could directly contribute to the improvement of the healthcare network. This research aimed to diagnose and analyse the current state of the processes and activities associated with the operating room of a hospital unit. It also explored the application of Lean Healthcare tools. The project followed the Action Research methodology, applying a practical and collaborative approach to analyse, identify, suggest and implement process improvements, promoting interdisciplinarity between engineering and hospital operations management. This proximity to a real-world context strengthens scientific knowledge in the field of process standardisation, highlighting Action Research as a valid scientific methodology capable of adding value both to institutions and, simultaneously, to the scientific community. Through the data analysis and in loco observation of more than 60 surgeries, it was possible to model preoperative, intraoperative and postoperative processes. This enabled the diagnosis of improvement opportunities. The results revealed that surgeries were frequently delayed due to issues related to medical resource availability. Additionally, operating rooms exhibited low occupancy rates. In response, the research team proposed revised scheduling strategies, implemented 5S audits, process standardization, control checklists and Single-Minute Exchange of Die (SMED) practices. These interventions led to a reduction in non-conformities and errors, including a decrease of over 40 percentage points in non-conformities related to the availability of medical devices. Although there is still a long way to go in Lean Healthcare research, this investigation contributes to a more efficient and robust healthcare network, implementing Lean Healthcare in the surgery department to deliver safer and higher-quality services with the patient at the centre of continuous improvement efforts.