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Our purpose is to optimize the human resource staffing levels. We want to minimize the patient average length of stay ([Formula: see text]), by integrating the staffing budget constraint and a constraint securing that the most severe incidents will see a doctor within a specified time limit. The second constraint allows to avoid the perverse effect of only considering the [Formula: see text] metric that would delay the treatment of the most urgent patients. We use simulation-based optimization, in which we perform a sensitivity analysis expressing [Formula: see text] as a function of the staffing budget and also the average door-to-doctor time for urgent patients ([Formula: see text]). We show that the budget has a diminishing marginal effect on the problem solution. Due to the correlation between [Formula: see text] and [Formula: see text], we also observe that the [Formula: see text] constraint may significantly affect the feasibility of the problem or the value of the optimal solution.<\/jats:p>","DOI":"10.1177\/0037549715606808","type":"journal-article","created":{"date-parts":[[2015,10,7]],"date-time":"2015-10-07T23:03:33Z","timestamp":1444259013000},"page":"942-953","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":48,"title":["Simulation-based optimization of staffing levels in an emergency department"],"prefix":"10.1177","volume":"91","author":[{"given":"Karim","family":"Ghanes","sequence":"first","affiliation":[{"name":"Laboratoire Genie Industriel, CentraleSup\u00e9lec, Universit\u00e9 Paris-Saclay, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathias","family":"Wargon","sequence":"additional","affiliation":[{"name":"Emergency Department, Saint Camille Hospital, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oualid","family":"Jouini","sequence":"additional","affiliation":[{"name":"Laboratoire Genie Industriel, CentraleSup\u00e9lec, Universit\u00e9 Paris-Saclay, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zied","family":"Jemai","sequence":"additional","affiliation":[{"name":"OASIS -ENIT, University of Tunis El Manar, Tunisia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agapitos","family":"Diakogiannis","sequence":"additional","affiliation":[{"name":"Laboratoire Genie Industriel, CentraleSup\u00e9lec, Universit\u00e9 Paris-Saclay, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romain","family":"Hellmann","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9s, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d\u2019Epid\u00e9miologie et de Sant\u00e9 Publique (IPLESP UMRS 1136), F75012, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Val\u00e9rie","family":"Thomas","sequence":"additional","affiliation":[{"name":"Sorbonne Universit\u00e9s, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d\u2019Epid\u00e9miologie et de Sant\u00e9 Publique (IPLESP UMRS 1136), F75012, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ger","family":"Koole","sequence":"additional","affiliation":[{"name":"Department of Mathematics, VU University Amsterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2015,10,7]]},"reference":[{"key":"bibr1-0037549715606808","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2008.03.014"},{"key":"bibr2-0037549715606808","unstructured":"Ghanes K, Diakogiannis A, Jouini O, Key performance indicators for emergency departments: A survey from an operations management perspective. 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