This work evaluates different patient flow management policies not only inside the intensive care unit (ICU), but in the complete patient flow (including emergency department (ED), intermediate care unit (IMC), ward, and operating theatre (OT)).
Rather than focusing on one specific type of patients, the researchers simulate 30 different patient paths covering almost all types of patients. Furthermore, medical and monetary KPIs are used to evaluate the performance. On top of that, the patient flow management model developed using simulation software is flexible to adjust the parameters. Therefore, it can be easily applied in different hospital settings.
Vice versa, control policies applied in the up- and downstream departments can also help to optimize the resource utilization and service quality in the ICU. Therefore, increasing the capacity in the IMC is an option to relieve the stress from the ICU. Additionally, rescheduling surgeries in the OT is another frequently applied method.
Any of the policies result in different consequences, such as the patient's health condition, the occupancy at other departments, etc. Most hospitals have no regulated process when it comes to making decisions on patient transfers, since it usually depends on the situation, such as the current utilization of the ICU.
About the Model
The patient flow simulation model is based on a dataset with 75,934 patient records in the year 2015 from one of the largest teaching hospitals in south Germany. The dataset covers 1,215 beds in general wards, 45 emergency beds, 20 IMC beds, and 30 ICU beds.
To figure out the best performance using simulation software, various patient flow management policies are evaluated. When the ICU is fully occupied, the patients will be arranged according to the policies. The cooperating hospital also provided a list of patients who are less critical. They can be early discharged when it is necessary.
In total, eleven patient flow management policies with corresponding procedures are evaluated in the simulation.
In general, the results gained using the simulation software indicate that the introduction of patient flow management policies has a positive impact on patient status, length of stay and/or costs.
Since the assessment of the effects of control policies is carried out by comparing simulation results under the same general conditions, valid decisions can be made. Finally, the managers can also make the decisions based on their own priorities and weighting of the KPIs.