Identification of Key Performance Indicators in Simulation-Based Studies for Hospital-Wide Efficiency: A Systematic Review

SUMMARY STATEMENT: This systematic review synthesizes 34 key performance indicators (KPIs) from 36 hospital-wide simulation studies (2000 to November 2025), adhering to the PRISMA 2020 guidelines. Using PubMed, Scopus, and Web of Science, studies were assessed via the Critical Appraisal Skills Programme checklist, with discrete event simulation dominating (83%). Departmental stratification revealed coverage of the emergency department in 78%, inpatient units in 56%, operating rooms in 31%, and outpatient clinics in 22% of studies. KPIs were categorized into structural (eg, utilization rate), process (eg, length of stay), and outcome (eg, patient throughput) indicators. A novel impact metric (% KPI improvement per simulation effort) and hybrid models integrating qualitative KPIs (eg, patient satisfaction) are proposed. This framework guides simulationists in designing validated models for hospital efficiency, with applications in logistics and manufacturing.