A Discrete Event Simulation Model to Support Bed Management

Paolo Landa, Michele Sonnessa, Elena Tànfani, Angela Testi

2014

Abstract

In recent years, due to the overcrowding of Emergency Department (ED) and the growing concern in reducing the number of inpatient ward beds, it has become crucial to improve the capacity planning and control activities, which manage the patient flows from EDs to hospital wards. Bed Management has a key role in this context. This study starts by a collaboration with the Local Health Government (LHG) of the Liguria region aimed at studying the impact of supporting bed management with some operational strategies without increasing the bed capacity. A large amount of data was collected over a one-year period at public hospital in Genova and a preliminary observational analysis was conducted to get the main information about the flow of emergency and elective patients from ED to inpatient wards. A Discrete Event Simulation (DES) model has been then developed in order to represent the real system. A scenarios analysis is proposed to assess the best strategy to improve the system performance without increasing bed capacity, by simply synchronizing bed supply and demand. The model can be used as a decision support tool to optimise the use of the available resources as well as to improve the quality of the patient pathway inside the hospital.

References

  1. Agenas (National Agency for Health Care Services), 2012. Monitor, Special Issue on the Emergency System. Roma, http://www.agenas.it/pubblicazioni/monitorrivista-agenas.
  2. Audit Commission, 1992. Lying in Wait: the Use of Medical Beds, in Acute Hospitals. HMSO. London.
  3. Audit Commission, 1993. Bed Management. HMSO. London.
  4. Bagust, A., Place, M., Posnett, J., 2003. Dynamics of bed use in accommodating emergency admissions: stochastic simulation model. British Medical Journal, 310 (7203), 155-158.
  5. Boaden, R., Proudlove, N., Wilson, M., 1999. An exploratory study of bed management. Journal of Management in Medicine, 13 (4), 234-250.
  6. Evans, B., Potvin, C., Johnson, G., Henderson, N., Yuen, I., Smith, T., Metham, S., Taylor, S., Sniekers, D., 2011. Enhancing Patient Flow in Acute Care Hospital: Successful Strategies at the Juravinski Hospital. Healthcare Quarterly, 14 (3), 66-75.
  7. Green, J,. Armstrong, D,. 1994. The views of service providers. In Morrell, D., Green, J., Armstrong, D., Bartholomew, J., Gelder, F., Jenkins, C., Jankowski, R., Mandalia, S., Britten, N., Shaw, A., Savill, R. (eds) Five Essays on Emergency Pathways, Institute, for the Kings Fund Commission on the future of Acute Services in London, Kings Fund, London.
  8. Haraden, C., Resar, R., Horton, S.S., Henderson, D., Dempsey, C., Appleby, D., 2004. Capacity Management: Breakthrough Strategies for Improving Patient Flow. Frontiers of Health Services Management, 20 (4), 3-15.
  9. Harper, P.R., Shahani, A.K., 2002. Modelling for the planning and management of bed capacities in hospitals. Journal of the Operational Research Society, 53, 11-18.
  10. Health Foundation, 2013. Improving patient flow across organisations and pathways. (retrived from http://www.health.org.uk/public/cms/75/76/313/4196/I mproving%20patient%20flow.pdf?realName=TxPs1T. pdf).
  11. Howell, E., Bessman, E., Kravet, S., Kolodne,r K., Marshall, R., Wright, S., 2008. Active Bed Management by Hospitalists and Emergent Department Throughput. Annals of Internal Medicine, 149; 804-810.
  12. Howell, E., Bessman, E., Marshall, R. Wright, S., 2010. Hospitalist bed management effecting throughput from the emergency department to the intensive care unit, Journal of Critical Care, 7(2); 184-189.
  13. IHI, Institute for Healthcare Improvement, 2003. Optimizing Patient Flow. Moving Patients Smoothly Through Acute Care Settings. Innovation Series 2003 paper, online article, retrieved June 14th 2014, http://hospitalmedicine.ucsf.edu/improve/optimizing_ pt_flow_white_paper2003.pdf .
  14. Jensen, A1, Boyle, J, Khanna, S., 2013. Visualising patient flow. Health Technology Information, 178, 77-82.
  15. Istat (National Institute Statistics in Italy), 2011. http://noiitalia2011.istat.it/index.php?id=7&user_100ind_pi1% 5Bid_pagina%5D=88&cHash=b52e8996296b53cd14c 5ef201bda574a.
  16. Law M.A., 2007. Simulation Modeling & Analysis. McGraw-Hill, 4th ed.
  17. Simeu, 2011. Standard organizzativi delle strutture di emergenza e urgenza. Organizational standards of A&E facilities, http://www.comesemergenza.it/files/ Standard_FIMEUC-SIMEU_2011.pdf (retrieved June 24th, 2014).
  18. Proudlove, N., Gordon, K., Boaden, R., 2003. Can good bed management solve the overcrowding in A&E?. Emergency Medicine Journal, 20 (2), 149-155.
  19. Proudlove, N., Boaden, R., Jorgensen, J., 2007. Developing bed managers: the why and the how. Journal of Nursing Management, 15, 34-42.
  20. Tortorella, F., Ukanowicz, D., Douglas-Ntagha, P., Ray, R., Triller, M., 2013. Improving bed turnover time with a bed management system. J Nurs Adm;43 (1), 37-43.
  21. Young, T., Brailsford, S., Connell, C., Davies, R., Harper, P., Klein, J.K., 2004. Using industrial processes to improve patient care. British Medical Journal, 328, 162-4.
  22. Vissers, J., Beech, R., 2005. Health Operations Management: Patient Flow Logistics in Health Care. Routledge, Oxon.
  23. Vanberkel, P.T., Boucherie, R.J., Hans, E.W., Hurink, J.L., Litvak, N., 2009. A Survey of Health Care Models that Encompass Multiple Departments, http://eprints.eemcs.utwente.nl/15762/01/memo1903.p df.
  24. Witness (2013). User guide. Lanner Group, London, U.K.
Download


Paper Citation


in Harvard Style

Landa P., Sonnessa M., Tànfani E. and Testi A. (2014). A Discrete Event Simulation Model to Support Bed Management . In Proceedings of the 4th International Conference on Simulation and Modeling Methodologies, Technologies and Applications - Volume 1: HA, (SIMULTECH 2014) ISBN 978-989-758-038-3, pages 901-912. DOI: 10.5220/0005161809010912


in Bibtex Style

@conference{ha14,
author={Paolo Landa and Michele Sonnessa and Elena Tànfani and Angela Testi},
title={A Discrete Event Simulation Model to Support Bed Management},
booktitle={Proceedings of the 4th International Conference on Simulation and Modeling Methodologies, Technologies and Applications - Volume 1: HA, (SIMULTECH 2014)},
year={2014},
pages={901-912},
publisher={SciTePress},
organization={INSTICC},
doi={10.5220/0005161809010912},
isbn={978-989-758-038-3},
}


in EndNote Style

TY - CONF
JO - Proceedings of the 4th International Conference on Simulation and Modeling Methodologies, Technologies and Applications - Volume 1: HA, (SIMULTECH 2014)
TI - A Discrete Event Simulation Model to Support Bed Management
SN - 978-989-758-038-3
AU - Landa P.
AU - Sonnessa M.
AU - Tànfani E.
AU - Testi A.
PY - 2014
SP - 901
EP - 912
DO - 10.5220/0005161809010912