Comprehensive review and future research agenda on discrete-event simulation and agent-based simulation of emergency departments

With the growing demand for hospital resources worldwide, healthcare facilities, including Emergency Departments (EDs), look for opportunities to enhance patient care efficiency and streamline healthcare processes. To achieve this, simulation techniques, including Discrete-Event Simulation (DES) and Agent-Based Simulation (ABS), started gaining awareness; however, little is known regarding their applications and integration with various optimization methods and scenario-generation techniques in EDs. To address this research gap, we used bibliometric analysis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework to narrow the publications to 62 articles and conduct a comprehensive review. During the evaluation of each article, three dimensions, namely the area of application, outcomes, and Key Performance Indicators (KPIs), were reviewed to understand the development and implementation of simulation techniques in EDs. The results shed light on the vital impact of process and time variations on simulation quality and the importance of involving healthcare professionals in simulation validation and verification. Furthermore, this study provided a conceptual framework that identified gaps and solutions related to the model scopes, approaches, technologies, and implementation of the DES and ABS in EDs. These findings could prove useful for healthcare researchers, practitioners, and managers in advancing the future research directions of DES and ABS and practical implications in the decision-making process.