<p>In this paper, we present a new application of Discrete Event Simulation (DES) as a Digital Twin (DT) for real-time monitoring of patient pathways (PPs) in a hospital. This application, which we call HospiT'Win, enables hospital managers and decision-makers to monitor and manage PPs in real time, supporting informed decision-making. Our approach relies on real-time synchronization between the DT and the PPs at each detected event in the hospital. This approach requires that the initial state of the simulation reflects the current state of the PPs in the hospital. For consistency, in the remainder of this paper, we refer to our approach as the DT of PPs. In this paper, we propose a real-time synchronization mechanism, based on DES, to synchronize the DT of PPs in a hospital with real PPs. This synchronization mechanism was tested using an emulator that mimics the stochastic processes of an outpatient clinic. The use of the proposed synchronization mechanism resulted in a dynamic DT that can track real PPs in hospitals in real time for each detected event. Moreover, this synchronization mechanism allowed for deeper analysis of the behavior of the emulated clinic through the DT and facilitated the detection of unexpected events. Quantitative evaluation showed an average synchronization latency of 0.73&#xa0;s and an accuracy of 97.7% in tracking patient locations and activities. Based on two facts illustrated in the state of the art: (1) PPs are considered to be one of the tools used to improve and manage health care resources, and (2) DES tools have been used to study and improve these pathways through offline approaches and historical data, we have developed a dynamic virtual representation based on DES that is synchronized to track PPs in the hospital in real time. This approach enables the study of pathway behavior in real time, ultimately supporting hospital managers and decision-makers in improving hospital services and managing resources according to the required level of service and efficiency.</p>