Improving inpatient care is a priority for all healthcare organizations to meet the overall objective of achieving a high level of patient satisfaction.
Driving up the quality, efficiency and productivity of patient care is not just about reducing delays; it is about changing the way we deliver care and manage processes to improve services for patients.
While this is an ongoing issue for patient outcomes and satisfaction, it is also a priority for healthcare systems themselves that seek to:
Using simulation to model this complex environment achieves a few key benefits:
Simulation allows you to experiment with new ways of optimizing your Operating Room and answer questions such as:
Simulation allows you to test these changes in a risk-free environment prior to implementation to ensure that the optimal process is determined with no detriment to patient care.
The flow of patients between inpatient hospital-based care and outpatient skilled nursing is well established. Frequent flyers move back and forth between the two settings, creating an environment where errors may occur during hand-offs, costs continue to escalate, and paperwork piles up.
There are many contributing factors to readmissions and other clinical outcomes, some of which are out of a hospital’s control, such as social and economic factors. However, there are some that are within a healthcare system’s influence.
This is where simulation can help to model this environment and achieve key benefits.
Having a baby is the most common reason for admission to hospital in England. NAO investigated whether maternity services could adapt to changes in demand and whether there was sufficient capacity to meet the Department of Health’s objectives of providing one-to-one care during labour at all times.
Their simulation suggested that there were enough beds and that they could probably absorb a relatively substantial increase in demand but provided evidence that providing one-to-one care during labour would be very challenging.
Around 940 people in Cornwall have a stroke each year. Immediate treatment is provided at acute hospitals in Truro, Plymouth or Barnstaple. Around 40% of these patients will require follow-on care in a Rehabilitation Stroke Unit (RSU) based in community hospitals.
Currently patients can choose which RSU to attend, but patients who choose to attend Bodmin are often unable to access a free bed. These patients are either sent to an alternative RSU, increasing travel times for patients and their families, or wait in the acute hospital, which can lead to delays in transferring new patients from A&E to a dedicated stroke ward.
This paper looks at bed blocking in the Cardiac Intensive Care Unit at Morriston Hospital and its impact on bed capacity.
Different wards, e.g. general ward, Intensive Therapy Unit, High Dependency Unit, are organized to provide different levels of patient care as they progress through the treatment pathway. Bed blocking occurs when patients are clinically ready to be discharged from specialized wards can't be transferred to wards offering reduced care because of no beds are available.
This has implications on throughput of clinical activity, as well as patients’ cost of treatment.
Improving emergency care is complex and depends on a range of factors including: daily and hourly variations, in patient demand, varying lengths of hospital stay, discharge practices, availability of health and social care services pre and post-discharge.
Understanding the impact of changing to 7 day working on the system is challenging, and stakeholders want to understand the resource implications for acute beds.
This project brought together the data and improvement evidence into a simulation that demonstrates best practice.
The aim of the study was to optimize the number of beds available in order to minimize cancellations of Elective surgery and maintain an acceptable level of bed-occupancy at a Critical Care Unit (CCU) of a large teaching hospital.
The simulation seeks to simulate the bed-occupancy of the CCU as well as monitoring any cancellations of Elective surgery. Several ‘what-if’ scenarios are run including increasing bed numbers, ‘ring-fencing’ beds for Elective patients, reducing length of stay to account for delayed discharge and changing the scheduling of Elective surgery, and the results are reported.
As part of reviewing the provision of emergency and unscheduled care, elective and rehabilitation services, NHS Ayrshire & Arran had to estimate the bed capacity requirements for all specialties under different care delivery scenarios.
Taking into consideration the volumes of patients attending the A&E departments and flowing through the different inpatient sites under various proposed models of care, they used simulation to aid decision making on the delivery of a range of services.
The paper reflects the difficulties in giving a recommended number of beds and the approach accepted.
Ever increasing demand with severe capacity and financial constraints, means NHS acute services will continue to struggle and needs to make sure that resources are utilized in the most effective way.
Acute services need to improve efficiency by enhancing the match of capacity and demand. They need to model the level of resources needed by patients in acute services as a function of demand factors, e.g. population projections by age group, with a range of supply issues.
It is vital to understand the patient pathway in order to demonstrate the full impact of change.
In this webinar our healthcare consultant Fiona Lindsey draws on recent simulation projects to consider the questions that need to be answered, the levels of complexity required and lessons learned for constructing simulation for bed management.
She describes how she worked with NHS IMAS to develop simulation to show the impact of 7 day working on bed capacity, and goes through the process of how she helped Royal Free tackle bed management. Fiona helped them build a simulation to understand their bed consumption by specialty for both emergency and electives and the impact this would have on their ER.
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