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Hospital occupancy and discharge strategies - a simulation based study.
Intern Med J. 2017 May 09;:
Authors: Qin S, Thompson C, Bogomolov T, Ward D, Hakendorf P
Abstract
BACKGROUND: Increasing demand for hospital services has resulted in more arrivals to emergency department (ED), increased admissions, and, quite often, access block and ED congestion, along with patients' dissatisfaction. Cost constraints limit an increase in the number of hospital beds, so alternative solutions need to be explored.
AIMS: The aims of this study were to propose and test different discharge strategies which, potentially, could reduce occupancy rates in the hospital, thereby improving patient flow and minimising frequency and duration of congestion episodes.
METHODS: We employed a simulation approach using HESMAD [1], [2]; a sophisticated simulation model capturing patient flow through a large Australian hospital from arrival at ED to discharge. A set of simulation experiments with a range of proposed discharge strategies were carried out. The results were tabulated, analysed and compared using common hospital occupancy indicators.
RESULTS: Simulation results demonstrated that it is possible to significantly reduce the number of days when a hospital runs above its base bed capacity. In our case study, this reduction was from 281.5 days to 22.8 days in the best scenario, and reductions within the above range under other scenarios considered.
CONCLUSION: Some relatively simple strategies, such as 24-hours discharge or discharge/relocation of long-staying patients, can significantly reduce overcrowding and improve hospital occupancy rates. Shortening administrative and/or some treatment processes has a smaller effect, although the latter could be easier to implement.
PMID: 28485885 [PubMed - as supplied by publisher]