Allen, Michael, Thornton, Steven and Cooke, Matthew (Professor of clinical systems design) (2011) Use of simulation to investigate resourcing priorities and bed use in generic models of elective and emergency clinical pathways. In: Emergency Care Intensive Support team Conference, Oct 2011 (Unpublished)

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Abstract

Objectives - to assess whether alternative methods of prioritising patients affects length of stay and bed use in simulation models of elective and emergency care pathways
Design - generic elective and emergency care pathways were modelled using process simulation software
Main outcome measures - length of stay, staff utilisation, bed occupancy
Results - Where admission priority (giving priority to bringing in new patients for start of treatment with priority reducing through to discharge) was used in a model of elective procedures length of stay continued to increase as bed numbers were increased despite the number of patients being treated and staff utilisation reaching a plateau at a lower bed number. Bed occupancy was consistently close to maximum even when an escalation or “unblocking” strategy was used to switch priority to the discharge step when there were few free beds available. Restricting bed numbers could avoid the increased length of stay. When discharge priority (always giving highest priority to discharge activities, with priority reducing back to admitting new patients) was used in the same elective surgery model length of stay was significantly reduced and length of stay and bed occupancy did not continue to rise as more beds were made available. When patient arrival was scheduled each day to match available clinical staff, application of discharge priority reduced length of stay and bed occupancy by about a third compared to admission priority. In an emergency care setting (where there is no control over patient arrival) length of stay within the emergency department increased as patient arrival rate increased with large increases in waiting time observed above 80% capacity utilisation. Application of discharge priority (for non-urgent cases) reduced average length of stay by a third or more compared to admission priority at high capacity utilisation.
Conclusions – the modelling suggests that the length of stay in elective wards or emergency departments and bed occupancy in elective wards may be significantly reduced by, in the absence of other urgent medical need, constantly giving highest priority to discharge activities, with reducing priority back through the care pathway. An escalation strategy of bed unblocking (prioritising discharge activities only when bed occupancy is close to maximum) may have little impact on overall length of stay.

Item Type:	Conference Item (Paper)
Subjects:	R Medicine > RA Public aspects of medicine
Divisions:	Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Hospital beds—Length of stay--Computer simulation, Hospital beds—Length of stay--Forecasting
Official Date:	2011
Dates:	Date Event 2011 Completion
Status:	Peer Reviewed
Publication Status:	Unpublished
Version or Related Resource:	Paper also presented at other NHS meetings run by ECIST
Conference Paper Type:	Paper
Title of Event:	Emergency Care Intensive Support team Conference
Type of Event:	Conference
Date(s) of Event:	Oct 2011
Related URLs:	Organisation

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