Scheduled Surgery Admissions and Occupancy at a Children's Hospital

Abstract

Scheduled admissions contribute significantly to variability in occupancy. Predictable patterns of admissions lead to high occupancy on some days and unused capacity on others, with few days being at an optimal level of occupancy. These predictable patterns suggest opportunities to improve hospital operations with changes in scheduled admission patterns, which present a different problem than random demand.

Emergency department and hospital crowding: causes, consequences, and cures

“…The remainder of hospital admissions are elective scheduled admissions which, historically, have been scheduled early in the week to suit the needs of specialty practices that tend to follow a more regular schedule of working hours. In fact, studies from The Journal of Hospital Medicine and the Annals of Surgery have demonstrated that elective surgical admissions can vary by a factor of 3 between weekdays [49,50]. These large variations in elective admissions create a bottleneck early in the week, resulting in elective patients competing directly with ED patients for intensive care unit (ICU) and floor beds.…”

Development, implementation and evaluation of a tool for forecasting short term demand for beds in an intensive care unit

“…Utilisation of intensive care resources needs to be balanced with the need to accommodate emergency referrals and the need to maintain the flow of planned patients through, and the utilisation of, operating theatres. Short-term fluctuations in demand for beds, for instance from current patient with longer lengths of stay or a surge in emergency referrals, can result in the cancellation of elective surgeries or refusals of emergency referrals due to lack of capacity [1][2][3][4]. One major constraint on capacity is the availability of specialised staff; if managers could have an early warning of busy periods, there might be scope to plan ahead [2,4].…”

“…Short-term fluctuations in demand for beds, for instance from current patient with longer lengths of stay or a surge in emergency referrals, can result in the cancellation of elective surgeries or refusals of emergency referrals due to lack of capacity [1][2][3][4]. One major constraint on capacity is the availability of specialised staff; if managers could have an early warning of busy periods, there might be scope to plan ahead [2,4]. It is also reasonable to suppose that there may be other, less tangible, benefits associated with staff being 'forewarned' of busy periods (see also Littig and Isken [5] and Chow [6]).…”

“…We outlined the mathematical approach in conference proceedings [11] but give here the full formulation of the model and details of its subsequent implementation and evaluation. The model complements the considerable existing literature on managing bed capacity that focuses on 'steady-state' demand [2,4,10,[12][13][14][15][16][17][18][19][20][21][22] or managing bed capacity in the short term but over a whole hospital [5,[23][24][25][26][27]. Calculating the transient distributions permits use of the model for tactical/operational decision making related to staffing and theatre planning rather than the strategic capacity planning of the sort informed by steady state models.…”