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.
Citation of this paper:
F. Rodrigues, G.S. Zaric, D.A. Stanford, Discrete event simulation model for planning Level 2 “step-down” bed needs using NEMS, In Operations Research for Health Care, 2017, ISSN 2211-6923, https://doi.org/10.1016/j.orhc.2017.10.001.