Simulation of the ambulatory processes in the biggest Brazilian cardiology hospital: a petri net approach

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Fabio Lima
Matheus Felipe Cortez
Patricia Pessoa Schmidt
Ana Karoline Silvério
Alfredo Manoel da Silva Fernandes
João Chang Júnior


This paper presents a simulation of an ambulatory processes using timed Petri net (TPN). The simulation considers the flow of patients in the biggest Brazilian cardiology hospital. The TPN is used as a decision support system (DSS) to improve the processes, to reduce the waiting time of the patients in the ambulatory and in this way to assure a high-quality service to the patients. Simulations were carried out using the software Visual Object Net++. This is a free software and therefore the presented solution is a low-cost solution. Providing a low-cost solution has a huge importance in this work since the hospital is kept from the government efforts and operates with limited financial resources. The patients’ flow in the hospital can be faced as a service and the modelling and optimization of these services bring more efficiency to the system as well as improve the human factors involved. The results proved that some changes could be made in the processes to improve the performance of the system.


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Author Biographies

Fabio Lima, Centro Universitário FEI

Centro Universitário FEI

Industrial Engineering Department


Matheus Felipe Cortez, Centro Universitário FEI

Centro Universitário FEI

Industrial Engineering Department


Patricia Pessoa Schmidt, Centro Universitário FEI

Centro Universitário FEI

Industrial Engineering Department


Ana Karoline Silvério, Centro Universitário FEI

Centro Universitário FEI

Industrial Engineering Department

Alfredo Manoel da Silva Fernandes, Incor-Universidade de São Paulor-HC

Incor-Universidade de São Paulor-HC

João Chang Júnior, Centro Universitário FEI

Centro Universitário FEI

Industrial Engineering Department


Araujo, C., Barros, C. P., & Wanke, P. (2014). Efficiency determinants and capacity issues in brazilian for-profit hospitals. Health Care Management Science, 17, 126–138.

Astilean, A., Avran, C., Folea, S., Silvasan, I., & Petreus, D. (2010). Fuzzy petri nets based decision support system for ambulatory treatment of non-severe acute diseases. IN: Automation Quality and Testing Robotics (AQTR)., 2010 IEEE International Conference, 1–6.

Bernardi, S., Mahulea, C., & Albareda, J. (2019). Toward a decision support system for the clinical pathways assessment. Discrete Event Dynamic Systems, 29, 91–125.

Brailsford, S. C., Harper, R., Patel, B., & Pitt, M. (2009). An analysis of the academic literature on simulation and modelling in health care. Journal of Simulation, 3, 130-140.

Cho, M., Song, M., & Yoo, S. (2015). A systematic methodology for outpatient process analysis based on process mining. International Journal of Industrial Engineering, 22(4), 480-493.

Datafolha (2019). Saúde supera segurança na lista de principais problemas do país, aponta Datafolha. Available: Access: 3rd March, 2019.

Dotoli, M., Fanti, M. P., Iacobellis, G., Martino, L., Moretti, A. M., & Ukovich, W. (2010). Modeling and management of a hospital department via petri nets. In: Health Care Management (WHCM)., 2010 IEEE Workshop On, 1–6.

Emami, S., & Doolen, T. (2015). Healthcare performance measurement: identification of metrics for the learning and growth balanced scorecard perspective. International Journal of Industrial Engineering, 22(4), 426-437.

Fanti, M. P., Mangini, A. M., Dotoli, M., & Ukovich, W. (2013). A three-level strategy for the design and performance evaluation of hospital departments. Systems, Man, and Cybernetics: Systems, IEEE Transactions on, 43(4), 742–756.

Fanti, M. P., Mangini, A. M., Ukovich, W., Lesage, J. J., & Viard, K. (2014). A petri net model of an integrated system for the health care at home management. In: Automation Science and Engineering (CASE)., 2014 IEEE International Conference On, 582–587.

Fanti, M., & Ukovich, W. (2014). Discrete event systems models and methods for different problems in healthcare management. In: Emerging Technology and Factory Automation (ETFA)., 2014 IEEE, 1–8.

Gul, M., & Guneri, A. F. (2016). Planning the future of emergency departments: Forecasting ED patient arrivals by using regression and neural network models. International Journal of Industrial Engineering, 23(2), 137-154.

Günal, M. M., & Pidd, M. (2010). Discrete event simulation for performance modelling in health care: a review of the literature. Journal of Simulation, 4, 42–51.

Hiraishi, K., Choe, S., Torii, K., Uchihira., & Tanaka, T. (2012). Modeling of complex processes in nursing and caregiving services. In: Systems, Man, and Cybernetics (SMC)., 2012 IEEE International Conference On, 1449–1454.

Hsie, F-S. (2017). A hybrid and scalable multi-agent approach for patient scheduling based on Petri net models. Applied Intelligence, 47, 1068–1086.

Khayal, I. S., & Farid, A. M. (2017). A dynamic model for a cyber-physical healthcare delivery system with human agents. In: Systems, Man, and Cybernetics (SMC)., 2017 IEEE International Conference On, 3624–3629.

Leite, C. R. M., Martin, D. L., Sizilio, G. R. M. A., Santos, K. E. A., & Araujo, B. G. (2010) Modeling of medical care with stochastic petri nets. In: Engineering in Medicine and Biology Society (EMBC)., 2010 Annual International Conference Of The IEEE, 1336–1339.

Li, Y., Wang, H., Li, Y., & Li, L. (2018). Patient assignment scheduling in a cloud healthcare system based on petri net and greedy based heuristic. Enterprise information systems, 30(4), 515–533.

Ling, S., & Schmidt, H. (2000). Time petri nets for workflow modelling and analysis. In: Systems, Man, and Cybernetics, 2000 IEEE International Conference On, 3039–3044.

Mahulea, C., Garcia-Soriano, J., & Colom, J. (2012). Modular petri net modeling of the Spanish health system. In: Emerging Technologies Factory Automation (ETFA)., 2012 IEEE 17th Conference On,1–8.

Mahulea, C., Mahuela, L., Garcia-Soriano, J. M., & Colom, J. M. (2014). Petri nets with resources for modeling primary healthcare systems. In: System Theory, Control and Computing (ICSTCC)., 2014 18th International Conference, 639–644.

Mahulea, C., Mahulea, L., Garcia-Soriano, J. M., & Colom, J. M. (2018). Modular Petri net modeling of healthcare systems. Flexible Services and Manufacturing Journal, 30, 329–357.

Murata, T. (1989). Petri nets: Properties, analysis and applications. Proceedings of the IEEE, 77(4), 541–580.

Peterson, J. L. (1981). Petri Net Theory and the Modeling of Systems. Prentice Hall.

Rau, C. L., Tsai, F., Liang, S. F., Tan, J. C., Syu, H. C., Jheng, Y. L., Ciou, T. S., & Jaw, F. S. (2013). Using discrete-event simulation in strategic capacity planning for an outpatient physical therapy service. Health Care Management Science, 16, 352–365.

Rohleder, T. R., Lewkonia, P., Bischak, D. P., Duffy, P., & Hendijani, R. (2011). Using simulation modeling to improve patient flow at an outpatient orthopedic clinic. Health Care Management Science, 14, 135–145.

Rys, M. J. (2011). Study on the effect of different arrival patterns on an emergency department’s capacity using discrete event simulation. International Journal of Industrial Engineering, 18(1), 40-50.

Silva, M. (2013). Half a century after carl adam petri’s ph.d. thesis: A perspective on the field. Annual Reviews in Control, 37(2), 191–219.

Suzuki, T., & Hamagami, T. (2014). Context awareness by unit-type evolutionary petri net for team medical care support. In: Systems, Man and Cybernetics (SMC)., 2014 IEEE International Conference On, 385–390.

Wang, H., & Zeng, Q. (2008). Modeling and analysis for workflow constrained by resources and nondetermined time: An approach based on petri nets. Systems, Man and Cybernetics, Part A: Systems and Humans, IEEE Transactions on, 38(4), 802–817.

Wang, J., Li, J., & Howard, K. (2013). A system model of work flow in the patient room of hospital emergency department. Health Care Management Science, 16, 341–351.

Xiong, H. H., Zhou, M., & Manikopoulos C. (1994). Modeling and performance analysis of medical services systems using petri nets. In: Systems, Man, and Cybernetics, 1994. Humans, Information and Technology., 1994 IEEE International Conference On, 2339–2342.

Zhou, J., Wang, J., & Wang, J. (2019). A Simulation Engine for Stochastic Timed Petri Nets and Application to Emergency Healthcare Systems. IEEE/CAA Journal of Automatica Sinica, 6(4), 969-980.