Shaowen Qin1, Campbell Thompson2, Tim Bogomolov1, Dale Ward1, Paul Hakendorf3. 1. School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, South Australia, Australia. 2. School of Medicine, University of Adelaide, Adelaide, South Australia, Australia. 3. Flinders Medical Centre, SA Health, Adelaide, South Australia, Australia.
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: 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 used a simulation approach using HESMAD (Hospital Event Simulation Model: Arrivals to Discharge) - 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 was carried out. The results were tabulated, analysed and compared using common hospital occupancy indicators. RESULTS: Simulation results demonstrated that it is possible to reduce significantly the number of days when a hospital runs above its base bed capacity. In our case study, this reduction was from 281.5 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-h discharge or discharge/relocation of long-staying patients, can significantly reduce overcrowding and improve hospital occupancy rates. Shortening administrative and/or some treatment processes have a smaller effect, although the latter could be easier to implement.
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: 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 used a simulation approach using HESMAD (Hospital Event Simulation Model: Arrivals to Discharge) - 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 was carried out. The results were tabulated, analysed and compared using common hospital occupancy indicators. RESULTS: Simulation results demonstrated that it is possible to reduce significantly the number of days when a hospital runs above its base bed capacity. In our case study, this reduction was from 281.5 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-h discharge or discharge/relocation of long-staying patients, can significantly reduce overcrowding and improve hospital occupancy rates. Shortening administrative and/or some treatment processes have a smaller effect, although the latter could be easier to implement.
Authors: David Ben-Tovim; Tim Bogomolov; Jerzy Filar; Paul Hakendorf; Shaowen Qin; Campbell Thompson Journal: Health Syst (Basingstoke) Date: 2018-09-28
Authors: Sonya Osborne; Gai Harrison; Angela O'Malia; Adrian Gerard Barnett; Hannah E Carter; Nicholas Graves Journal: BMJ Open Date: 2018-12-22 Impact factor: 2.692
Authors: Lauren Cadel; Sara J T Guilcher; Kristina Marie Kokorelias; Jason Sutherland; Jon Glasby; Tara Kiran; Kerry Kuluski Journal: BMJ Open Date: 2021-02-11 Impact factor: 2.692