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Workshop looking at how simulation software can be used to manage hospital bed capacity.
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SIMUL8 Corporation | SIMUL8.com | [email protected]
SIMUL8 Corporation | SIMUL8.com | [email protected]
Overview
• Current challenges
• Case studies
• Learning
• Benefits
• Future thoughts
SIMUL8 Corporation | SIMUL8.com | [email protected]
Headlines
SIMUL8 Corporation | SIMUL8.com | [email protected]
Challenges
• Long waits in emergency departments
• Balancing elective vs. emergency demand
• Wrong bed wrong time
• Discharge placements
• Cancelled electives
• COMPLEX
SIMUL8 Corporation | SIMUL8.com | [email protected]
NHS IMASSupporting Improvements in Emergency Care
Purpose
• Educational simulations to
demonstrate best practice
concepts
• Increase adoption of best
practice concepts
• Highlight which improvement
concept to focus efforts
SIMUL8 Corporation | SIMUL8.com | [email protected]
The Simulation
• Arrivals (Acute Only) – Hour of Day/Day of
Week
• Patient Types – Age and GP referral
SIMUL8 Corporation | SIMUL8.com | [email protected]
The Simulation
• LOS – Samples likely number of midnight
stays
• Hour of day and day of week dependent
• Discharge – Samples likely discharge hour
• Calculates time until midnight, adds on
midnight stays and hour of discharge
SIMUL8 Corporation | SIMUL8.com | [email protected]
The Simulation
• Constraints – total number of beds
• Key results
SIMUL8 Corporation | SIMUL8.com | [email protected]
Scenarios
• Users select from pre
defined scenarios
• Scenarios cover key
improvements to help
alleviate bed constraints
• Users can also upload
own data to test
SIMUL8 Corporation | SIMUL8.com | [email protected]
GP/ PCP Referrals
• Referrals arriving 5pm• ED saturated at this point • Move to 1pm
SIMUL8 Corporation | SIMUL8.com | [email protected]
Discharges
• High % of patients
discharge towards
end of day
• Ability to move the
curve forward by ‘x’
hours
SIMUL8 Corporation | SIMUL8.com | [email protected]
Over 75’s
• Better management of
over 75’s
• Reducing LOS of those
with 14+ midnight stays
• Support being available in
the community
SIMUL8 Corporation | SIMUL8.com | [email protected]
7 Day Working
• Reduced number of
discharges over
weekend
• Staff available to make
the discharge decisions
• Apply a weekday LOS
profile to Sat/Sun
admissions
SIMUL8 Corporation | SIMUL8.com | [email protected]
Results
SIMUL8 Corporation | SIMUL8.com | [email protected]
Royal Free HospitalManaging Elective and Emergency Admissions
Purpose
• Understand bed
consumption by specialty
• Understand bed
consumption by elective
and emergency
• Reduce ED waits
• Reduce elective
cancellations
SIMUL8 Corporation | SIMUL8.com | [email protected]
The Simulation
Arrivals Emergency – Hour of day/Day of Week by specialty
and emergency type.
Elective – Schedules by specialty, Day of Week and
month. Arrival time sampled separately.
Patient Types
• Admission type
• Arrival type
• Specialty
SIMUL8 Corporation | SIMUL8.com | [email protected]
The Simulation
LOS
– Dependent on admission type, specialty ,
hour of day and day.
– If 0 Midnight stays samples resample from
separate LOS distribution
SIMUL8 Corporation | SIMUL8.com | [email protected]
The Simulation
Constraints
• Number of beds by ward
• Ward dependent on specialty
• Top specialty attendances to ward used to create priority matrix
• Resource Pools representing wards created for each specialty
• Checks bed availability, if no preferred wards remain takes any bed
from the pool
Ward Identifier
SIMUL8 Corporation | SIMUL8.com | [email protected]
The Simulation
Discharge specialty’s
• Specialty change
• Ward Movements
• LOS sampled from
predicted
discharge
specialty
SIMUL8 Corporation | SIMUL8.com | [email protected]
The Simulation
• Overflow wards
– Available at certain times
– Overnight only
• % Routed to Short Stay Wards
– Not part of simulated beds
• Bed changeover time
• Emergency patients are priority for beds
SIMUL8 Corporation | SIMUL8.com | [email protected]
Results
• Select specialty/ward• Select Admission Type• Select Time Interval
View Results by
• Max Bed Occupancy • Admissions• Discharges
SIMUL8 Corporation | SIMUL8.com | [email protected]
Whole Hospital Simulation
Module 1 Module 2 Module 3 Module 4
SIMUL8 Corporation | SIMUL8.com | [email protected]
Lessons
• Simple vs. Complex Simulations
– What are the minimum requirements?
• Arrival Data
– Only shows time bed was occupied
– Simulate delay
– Shift arrival curve
• LOS Data
– Time Dependent, Specialty Dependent, Ward Dependent,
Admission Dependent
– Data Sparse for some specialties
SIMUL8 Corporation | SIMUL8.com | [email protected]
Lessons
• Discharge time – batching
vs.
• Rules – Difficult to define
– Triggers
– Simulation driving understanding
SIMUL8 Corporation | SIMUL8.com | [email protected]
Lessons
• Specialty vs. Wards
– Visual representation important
• Validation
– Bed Census
– Closed Wards
SIMUL8 Corporation | SIMUL8.com | [email protected]
Lessons
Scenario Assumptions – How do you model
7 day working?
Actually increased
capacity required
SIMUL8 Corporation | SIMUL8.com | [email protected]
Lessons
Number of midnight
stays appear to be
driven by a push to
discharge on Friday.
Clear the system before
weekend rush.
If 7 day working, no rush to discharge
before Friday. What is a clinically
appropriate LOS?
SIMUL8 Corporation | SIMUL8.com | [email protected]
Benefits of using simulation
• Interconnectedness – See the effect in
ED, on Bed Utilization and on waiting lists
• Complex Routes and Rules – Simulation
helped engage and define complexities in
process
• Visualization
• Experimentation
SIMUL8 Corporation | SIMUL8.com | [email protected]
Future
• Generic bed modeling simulation
– How complex/simple does this need to be?
• Connecting to real time data
• Linking modules
SIMUL8 Corporation | SIMUL8.com | [email protected]