Allocating Emergency Beds Improves the Emergency Admission Flow

A. J. Thomas Schneider (), P. Luuk Besselink (), Maartje E. Zonderland (), Richard J. Boucherie (), Wilbert B. van den Hout (), Job Kievit (), Paul Bilars (), A. Jaap Fogteloo () and Ton J. Rabelink ()
Additional contact information
A. J. Thomas Schneider: Department of Quality & Patient Safety, Leiden University Medical Center, Leiden 2333 ZA, Netherlands; Center for Healthcare Operations Improvement and Research, University of Twente, Enschede 7500 AE, Netherlands;
P. Luuk Besselink: ORTEC Consulting, Houston, Texas 77027
Maartje E. Zonderland: Center for Healthcare Operations Improvement and Research, University of Twente, Enschede 7500 AE, Netherlands
Richard J. Boucherie: Center for Healthcare Operations Improvement and Research, University of Twente, Enschede 7500 AE, Netherlands
Wilbert B. van den Hout: Department of Medical Decision Making, Leiden University Medical Center, Leiden 2333 ZA, Netherlands
Job Kievit: Department of Medical Decision Making, Leiden University Medical Center, Leiden 2333 ZA, Netherlands
Paul Bilars: Department of Internal Medicine, Leiden University Medical Center, Leiden 2333 ZA, Netherlands
A. Jaap Fogteloo: Department of Internal Medicine, Leiden University Medical Center, Leiden 2333 ZA, Netherlands
Ton J. Rabelink: Department of Internal Medicine, Leiden University Medical Center, Leiden 2333 ZA, Netherlands

Interfaces, 2018, vol. 48, issue 4, 384-394

Abstract: The increasing number of admissions to hospital emergency departments (EDs) during the past decade has resulted in overcrowded EDs and decreased quality of care. The emergency admission flow that we discuss in this study relates to three types of hospital departments: EDs, acute medical unit (AMUs), and inpatient wards. This study has two objectives: (1) to evaluate the impact of allocating beds in inpatient wards to accommodate emergency admissions and (2) to analyze the impact of pooling the number of beds allocated for emergency admissions in inpatient wards. To analyze the impact of various allocations of emergency beds, we developed a discrete event simulation model. We evaluate the bed allocation scenarios using three performance indicators: (1) the length of stay in the AMU, (2) the fraction of patients refused admission, and (3) the utilization of allocated beds. We develop two heuristics to allocate beds to wards and show that pooling beds improves performance. The partnering hospital has embedded a decision support tool based on the simulation model into its planning and control cycle. The hospital uses it every quarter and updates it with data on a 1-year rolling horizon. This strategy has substantially reduced the number of patients who are refused emergency admission.

Keywords: acute medical unit; emergency department; inpatient wards; hospitals; emergency admissions; systems optimization; discrete-event simulation; length of stay; operations efficiency; decision support (search for similar items in EconPapers)
Date: 2018
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Citations: View citations in EconPapers (2)

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