SEVERE BRAIN INJURED PATIENTS: MODEL AND SIMULATION TO IMPROVE ASSISTANCE MANAGEMENT

The organization of health care systems represents an essential service for the community. In this paper we analyze the care pathways for severe brain injured patients, which have heterogeneous needs and characteristics throughout each phase of the healthcare assistance, with the scope of a correct dimensioning of resources at disposition, in order to satisfy patients needs, both in present and future situation, consequent to population growth in time. First an accurate description of acquired brain injury and of consequent disorders of consciousness is presented; related required health care, developed in successive phases according to the disease development, is accurately examined; acquired brain injury epidemiology is reported from the literature. We develop a simulation model written in language Arena® that represents the health care assistance and rehabilitation, able to provide the behaviour of system demand, the patient queues statistics, the resource utilization and availability. Such a model was applied to the assistance offered by the Veneto Region Healthcare System; the simulation results showed the assistance deficiencies that will take place the next years in long term assistance; we propose a solution (increase of some resources at disposition) to improve the assistance for patients in vegetative state and minimally conscious state.