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?