Dependence between Arrival and Service Processes in Healthcare Simulation Modelling

Analytical and simulated queuing models are useful for understanding and improving healthcare systems, including emergency departments (EDs), which serve as vital access points to healthcare systems internationally. EDs face challenges such as long waiting times, ambulance queuing, and bed-blocking, and simulation can be used to test strategies for improving these problems. Despite the widespread use of simulation, there is a lack of literature addressing the validity of queuing theory assumptions underpinning it, particularly the assumption of independence between the arrival and service processes. This paper employs semi-experiments to test these assumptions using real ED data. The results indicate that a correlation structure is present between the arrival and service processes in this data. The implications for simulation studies and directions for future work are discussed.