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It spans the full spectrum of operational, clinical, and financial perspectives, over varying horizons: operational\u2014a few hours or days ahead; tactical\u2014weeks or a few months ahead; and strategic, which involves planning on monthly and yearly scales. Simulation offers a natural framework within which to address these challenges, as realistic ED models are typically intractable analytically. We apply a general and flexible ED simulator to address several significant problems that arose in a large Israeli hospital. The article focuses mainly, but not exclusively, on workforce staffing problems over these time horizons. First, we demonstrate that our simulation model can support real-time control, which enables short-term prediction and operational planning (physician and nurse staffing) for several hours or days ahead. To this end, we present a novel simulation-based technique that implements the concept of offered-load and discover that it performs better than a common alternative. Then we evaluate ED staff scheduling that adjusts for midterm changes (tactical horizon, several weeks or months ahead). Finally, we analyze the design and staffing problems that arose from physical relocation of the ED (strategic yearly horizon). Application of the simulation-based approach led to the implementation of our design and staffing recommendations.<\/jats:p>","DOI":"10.1145\/2000494.2000497","type":"journal-article","created":{"date-parts":[[2011,9,6]],"date-time":"2011-09-06T15:10:32Z","timestamp":1315321832000},"page":"1-25","update-policy":"https:\/\/doi.org\/10.1145\/crossmark-policy","source":"Crossref","is-referenced-by-count":74,"title":["Simulation-based models of emergency departments:"],"prefix":"10.1145","volume":"21","author":[{"given":"Sergey","family":"Zeltyn","sequence":"first","affiliation":[{"name":"IBM Research Laboratory, Haifa, Israel"}]},{"given":"Yariv N.","family":"Marmor","sequence":"additional","affiliation":[{"name":"Technion\u2014Israel Institute of Technology, Haifa, Israel"}]},{"given":"Avishai","family":"Mandelbaum","sequence":"additional","affiliation":[{"name":"Technion\u2014Israel Institute of Technology, Haifa, Israel"}]},{"given":"Boaz","family":"Carmeli","sequence":"additional","affiliation":[{"name":"IBM Research Laboratory, Haifa, Israel"}]},{"given":"Ohad","family":"Greenshpan","sequence":"additional","affiliation":[{"name":"IBM Research Laboratory, Haifa, Israel"}]},{"given":"Yossi","family":"Mesika","sequence":"additional","affiliation":[{"name":"IBM Research Laboratory, Haifa, Israel"}]},{"given":"Sergev","family":"Wasserkrug","sequence":"additional","affiliation":[{"name":"IBM Research Laboratory, Haifa, Israel"}]},{"given":"Pnina","family":"Vortman","sequence":"additional","affiliation":[{"name":"IBM Research Laboratory, Haifa, Israel"}]},{"given":"Avraham","family":"Shtub","sequence":"additional","affiliation":[{"name":"Technion\u2014Israel Institute of Technology, Haifa, Israel"}]},{"given":"Tirza","family":"Lauterman","sequence":"additional","affiliation":[{"name":"Technion\u2014Israel Institute of Technology, Haifa, Israel"}]},{"given":"Dagan","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Rambam Health Care Center, Haifa, Israel"}]},{"given":"Kobi","family":"Moskovitch","sequence":"additional","affiliation":[{"name":"Rambam Health Care Center, Haifa, Israel"}]},{"given":"Sara","family":"Tzafrir","sequence":"additional","affiliation":[{"name":"Rambam Health Care Center, Haifa, Israel"}]},{"given":"Fuad","family":"Basis","sequence":"additional","affiliation":[{"name":"Rambam Health Care Center, Haifa, Israel"}]}],"member":"320","published-online":{"date-parts":[[2011,9,2]]},"reference":[{"key":"e_1_2_1_1_1","unstructured":"Asmussen S. and Glynn P. 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