Operations Research for Health Care
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In highly congested hospitals it may be common for patients to overstay at Intensive Care Units (ICU) due to blockages and imbalances in capacity. This is inadequate clinically, as patients occupy a service they no longer need; operationally, as it disrupts flow from upstream units; and financially as ICU beds are more expensive than ward beds. Step-down beds, also known as Level 2 beds, have become an increasingly popular and less expensive alternative to ICU beds to deal with this issue. We developed a discrete event simulation model that estimates Level 2 bed needs for a large university hospital. The model innovates by simulating the entirety of the hospital’s inpatient flow and most importantly, the ICU’s daily stochastic flows based on a nursing workload scoring metrics called “Nine Equivalents of Nursing Manpower Use Score” (NEMS). Using data from a large academic hospital, the model shows the benefits of Level 2 beds in improving both patient flow and costs.
Available for download on Saturday, November 16, 2019