Daily nurse requirements planning based on simulation of patient flows

Abstract

Nurses account for approximately 50 % of total hospital budgets and their allocation to medical units and shifts can significantly affect the quality of care provided to patients. The adoption of flexible shift schedules and the assessment of actual nursing time can enable sensible resource planning, balancing the quality of care with efficiency in resource use. Starting from the concept that nurse requirements are triggered by patient needs, which are stochastic in nature both for clinical activities and their duration, this paper proposes an innovative Nurse Requirement Planning model grounded on the concept of the clinical pathway (the “standard” sequence of diagnostic, therapeutic and care activities a patient with certain pathology should undertake over time) with its inner routing probability and patient dependence on nurses, which can be correlated to the time needed to perform nursing tasks. In merging and modelling these two aspects, the method summarizes the best features of acuity-quality and timed-task/activity techniques, well known although not usually applied for reasons of demands on clinicians’ time. Instead, in this paper, for each shift of the day, hospital management is enabled to choose the optimal number of nurses to meet actual requirements according to a desired service level and personnel saturation by means of a tool that simulates the patient flow in a medical unit based on automatic data retrieval from hospital databases. The validation and verification of the proposal were undertaken in a stroke unit. © 2015, Springer Science+Business Media New York

Clinical pathway modelling: a literature review

“…Eleven papers specifically stated other methods of collecting the information on the pathway, which are as follows - [19,22,41,82,116,169] stated that the information was provided to them in some way, [79] through previous work (also consulted with experts and stakeholders), [128] online user input, and [21,24,60] used national guidelines.…”

“…JCR Category MI [3, 11, 13, 14, 16, 17, 19, 32, 37, 42, 45-47, 52, 54, 56, 57, 66, 72, 73, 1-93, 95-97, 99-101, 108, 122, 124, 131, 140, 144, 149, 150, 157, 160, 164, 170, 178, 187, 196, 197, 206, 211] OR/MS [7,8,12,18,22,23,27,30,31,43,50,51,64,75,79,90,113,114,134,151,158,165,169,190,203,212] HPS [9, 10, 21, 33, 39, 40, 80, 102-104, 110, 116, 141, 143, 153, 163, 166, 209] IE [34,120] AN [53,133] No ISSN [15,24,36,60,70,71,82,127,138,139,142,161,183,[198][199][200] Table A4. Way in which information about the pathway was obtained.…”

“…Obtained Data Driven [5, 7-9, 11, 13, 32, 33, 37, 47-49, 54, 58, 62, 66, 70-72, 74-76, 80, 81, 83, 85-99, 104, 107, 108, 112, 120, 121, 124, 126, 127, 131, 133, 134, 138-140, 143, 144, 147-150, 153, 157, 160, 162, 167, 170, 172, 177-179, 183-185, 191, 192, 195, 197-206, 209-211] Collaboration [3,10,14,17,27,42,51,73,100,114,142,152,163] Both [12,20,35,40,56,101,103,129,136,146,154,166,171,186] Other [19,21,22,24,41,60,79,82,116,128,169] Table A6. Care level considered.…”

“…Scope Hospital [8, 21, 23, 27, 29-31, 36, 41, 51, 64, 67, 74-76, 79, 85, 108, 111, 114-117, 134, 142, 145-148, 152, 158, 160, 165, 166, 170, 177, 178, 184, 190, 202, 203, 209] Department [12,14,15,17,18,46,50,52,57,62,68,100,113,125,129,141,151,153,154,161,163,164,167,169,171,182,185,187,212] Clinical [1, 3, 5, 10, 11, 13, 16, 19, 20, 22, 32-35, 40, 42, 43, 45, 47, 53, 60, 70-73, 80-83, 87-99, 102, 107, 110, 112, 121, 124, 126-128, 133, 136, 139, 140, 149, 162, 179, 183, 186, 188, 191, 192, 195, 197-201, 204-206, 210, 211] Disease [4, 7, 9, 13, 24, 25, 37, 39, 43, 48, 49, 54-56, 58, 66, 86, 101-104, 118-120, 122, 128, 131, 138, 143, 144, 150, 157, 172, 196, 211] Table A5…”

Contributing to Sustainable Healthcare Systems with Case Theory

“…As researchers, they were asked to identify a method for sizing the nursing staff in a hospital (Sarno & Nenni, 2016). As marketing and management professors, they had to explain to students what the production implications of a clinical pathway are (capacity or resources, etc.)…”