Integral resource capacity planning for inpatient care services based on bed census predictions by hour

Abstract

The design and operations of inpatient care facilities are typically largely historically shaped. A better match with the changing environment is often possible, and even inevitable due to the pressure on hospital budgets. Effectively organizing inpatient care requires simultaneous consideration of several interrelated planning issues. Also, coordination with upstream departments like the operating theatre and the emergency department is much-needed. We present a generic analytical approach to predict bed census on nursing wards by hour, as a function of the Master Surgical Schedule and arrival patterns of emergency patients. Along these predictions, insight is gained on the impact of strategic (ie, case mix, care unit size, care unit partitioning), tactical (ie, allocation of operating room time, misplacement rules), and operational decisions (ie, time of admission/discharge). The method is used in the Academic Medical Center Amsterdam as a decision-support tool in a complete redesign of the inpatient care operations.

Managing urgent care in hospitals

“…The exception are studies that model non-elective patient pathways across the entire hospital (e.g., [33,90,157]). For example, [147] present an analytical approach to predict bed census on wards taking into account the Master Surgery Schedules (MSS) from the operating theater, as well as arrival rates from the ED. The arrival rates from the ED are considered as input however, and no further ED details are modeled.…”

“…Urgent care planning and scheduling additional process steps may be difficult. However, to gain insights into the interaction between hospital departments it may be sufficient to only include key components (e.g., [17,147,174]). …”

“…This interaction is also evaluated through bed allocation [18,147,226]. Wards also have a tandem effect, for example as patients flow through acute care and post-acute care units, and the allocation of beds may be optimized to reduce blocking between wards [37,246].…”

“…Trade-offs are sought between the utilization of wards and beds, and the blocking probability of a ward (i.e., the probability a patient can not be admitted). Both more specialized wards such as PACUs [18,61,226] and medium and intensive care units (ICU) [2,17,18,125,169] are considered, as well as regular wards [18,147]. When wards are included, the recovery of patients after surgery Ambulatory [29,33,90,157,174] [ 33,90,157,260] is modeled alongside the OR, and patients must be scheduled such that not only an OR is available, but also a post surgery bed.…”

“…Ward planning studies mostly optimize the allocation of beds to various patient types (e.g., reserve beds for non-electives and electives), as well as dimensioning for different medical specialties [2,17,18,22,50,83,90,109,125,147,150,151,171]. Complete hospital bed planning is also modeled [24,109,151,242], and when wards are evaluated, elective patients may also be included [24,103,125,146].…”