acute bed simulation russell emeny, fiona lindsay, claire cordeaux thanks to terry young, sally...

Acute Bed Simulation

Russell Emeny, Fiona Lindsay, Claire Cordeaux

Thanks to Terry Young, Sally Brailsford and Joe Viana

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Our Aim - Driving Best Practice

• Key improvement messages

• Demonstrated using simulation

• Uses default data for immediate testing

• Local hospital data can be uploaded

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Answering Questions

• What is my bed occupancy %?

• How many beds am I using?

• What are my wait times for beds?

• How do improvement scenarios impact on these results?

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Simulation Model

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Parameter 1 - Admissions

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Parameter 2 – Length of StayNumber of midnight stays by hour and day of the week

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Parameter 3 – Discharge profile

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Parameter 4 - Beds

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Improvement Scenario 1

What if GP referrals arrived earlier in the day?

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Improvement Scenario 2

What if our ambulatory care patients were treated elsewhere?

•Select a percentage of

admissions classed as

“ambulatory” (default 25%)

•Select likely impact on number

of midnight stays

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Improvement Scenario 3

Patients who stay for less than 2 midnights

•Research suggests 65% of patients

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Move patient discharges forward to earlier in the day

Improvement Scenario 4

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Improvement Scenario 5

Reduce 14 night length of stay for over 75s

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Which scenario has the most impact?

1. GP referrals earlier?

2. Ambulatory care treated elsewhere? (25% of admissions)

3. Increase proportion of stays that are less than 2 midnights?

4. Move 50% of discharges earlier in the day?

5. Reduce 14 night stays for over 75s? (25% of admissions)

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Results are in…

Which would you implement first?

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7 Day Working – Current Question

• How to model this?

• Staff available 7 days a week to make discharge decisions

• Use a Monday profile (furthest from the weekend)

• What would you expect to see?

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7 Day Working – Current Question

Actually increases capacity required

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Why?

Looking at 0-7 midnight stays – around 75% of admissions

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Impact of the weekend

Number of midnight

stays appear to be

driven by a push to

discharge on Friday

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7 day compared to Monday profile

• Patients are more likely to be discharged at the weekend• Have a longer length of stay during the week

Midnight stays 7 day profile Monday only

0 3565.8 3495.8 701 2772.5 2679.6 92.92 1910.4 2125.9 -215.53 1485.4 1615.6 -130.24 1076.5 1323 -246.55 786.5 574.7 211.86 702.1 398.3 303.8

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What next?

• Currently being tested with 3 hospitals for usability

• Presenting a poster at 7 Day Working event November 16th

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Continuing the Work

• More questions emerging

• Informing national debate on emergency care and 7 day working

• Disseminate to hospitals

• Seeking support

• Link with research interests?