Mathematical modelling and simulation for planning critical care capacity*

Costa, Afb; Ridley, S.; Shahani, A. K.; Harper, Paul Robert; Senna, Valter de; Nielsen, M. S.

doi:10.1046/j.1365-2044.2003.03042.x

Cited by 123 publications

(86 citation statements)

References 12 publications

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“…We developed a discrete event simulation model [6,7], using the simulation software tool eM-Plant (Plano, USA). This simulation model was a representation of the Erasmus MC 12 OR set-up.…”

Section: Methodsmentioning

confidence: 99%

Closing Emergency Operating Rooms Improves Efficiency

et al. 2007

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Long waiting times for emergency operations increase a patient's risk of postoperative complications and morbidity. Reserving Operating Room (OR) capacity is a common technique to maximize the responsiveness of an OR in case of arrival of an emergency patient. This study determines the best way to reserve OR time for emergency surgery. In this study two approaches of reserving capacity were compared: (1) concentrating all reserved OR capacity in dedicated emergency ORs, and (2) evenly reserving capacity in all elective ORs. By using a discrete event simulation model the real situation was modelled. Main outcome measures were: (1) waiting time, (2) staff overtime, and (3) OR utilisation were evaluated for the two approaches. Results indicated that the policy of reserving capacity for emergency surgery in all elective ORs led to an improvement in waiting times for emergency surgery from 74 (±4.4) minutes to 8 (±0.5) min. Working in overtime was reduced by 20%, and overall OR utilisation can increase by around 3%. Emergency patients are operated upon more efficiently on elective Operating Rooms instead of a dedicated Emergency OR. The results of this study led to closing of the Emergency OR in the Erasmus MC (Rotterdam, The Netherlands).

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“…We developed a discrete event simulation model [6,7], using the simulation software tool eM-Plant (Plano, USA). This simulation model was a representation of the Erasmus MC 12 OR set-up.…”

Section: Methodsmentioning

confidence: 99%

Closing Emergency Operating Rooms Improves Efficiency

et al. 2007

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“…Many models do not include crucial management responses to demand; in reality there may be opportunities to manage admissions, as in the HLC, or expedite patient transfer or discharge of patients. Ignoring such management responses can lead to overestimates of the capacity requirements (Costa et al, 2003). In some units, there may be the possibility to expedite the transfer of some patients out of the ICU if occupancy levels are high, or extending the stay when occupancy is low (Mallor & Azcárate, 2011).…”

Section: Modelling Icu's and The Balance Of Resourcesmentioning

confidence: 99%

Balancing operating theatre and bed capacity in a cardiothoracic centre

Bowers

2013

Health Care Manag Sci

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This paper examines the balance between operating theatre and bed capacity in a specialist facility providing elective heart and lung surgery. The capacity of the whole facility is determined by the availability of operating theatre time and Intensive Care beds: without both resources surgery has to be postponed. Although the admissions can be managed, there are significant stochastic components, notably the cancellation of theatre procedures and patients' length of stay on the Intensive Care Unit. A simulation was constructed to explore the interdependencies of resource availabilities and the daily demand. The model was developed with clinical and management staff to explore options for expanding the capacity of the whole facility. Ideally the bed and theatre capacity should be well balanced but unmatched increases in the capacity of either resource can still be beneficial. The study provides an example of a capacity planning problem in which there is uncertainty in the demand and availabilities of two symbiotic resources.

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“…Lack of ICU beds to admit emergency patients has been cited as one of the reasons for overcrowding the Emergency Rooms (ER) and long wait times that has become a national issue and has contributed to cancellation of elective surgical procedures and has impacted the surgical wait list [13,14] . Despite the pressures to reduce the wait times and progresses in some areas, a recent report by Canadian Institute for Health Information (CIHI) suggests that in Canadian ERs, one patient out of ten waits eight or more hours to be seen [15] .…”

Section: Discussionmentioning

confidence: 99%

An on-line dashboard to facilitate monitoring of provincial ICU bed occupancy in Alberta, Canada

Shahpori

Gibney

Guebert

et al. 2013

JHA

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Intensive Care Unit (ICU) beds are among the most valuable hospital resources for which demands periodically exceed supplies. Hence monitoring and management of utilization of these resources is essential for providing an efficient and equitable service. The purpose of this article is to describe the design, development and utilization of a dashboard for the measurement of occupancy and management of capacity of a provincial network of ICUs. The dashboard utilizes the exiting hospital data sources and infrastructure to provide a timely snapshot of bed utilization as well as a historical view of unit occupancy and enables simulation scenarios for capacity planning in a dispersed geographical location. This information is used by administration for managing the scarce ICU resources and helping with standardization of admit and discharge processes to and from intensive care units in order to enhance efficiency. In our case, the existing hospital information systems proved to contain reliable data and the existing information technology infrastructure owned proper resources to be accessed to develop such valuable tool. Such dashboard presents necessary information to facilitate understanding of capacity and bed utilization and can help create a sense of community and standardization of critical care services which would eventually contribute to a more equitable and efficient health system.

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Mathematical modelling and simulation for planning critical care capacity*

Cited by 123 publications

References 12 publications

Closing Emergency Operating Rooms Improves Efficiency

Closing Emergency Operating Rooms Improves Efficiency

Balancing operating theatre and bed capacity in a cardiothoracic centre

An on-line dashboard to facilitate monitoring of provincial ICU bed occupancy in Alberta, Canada

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