Go with the flow
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Go with the flow Modelling bed occupancy and patient flow through a geriatric department
Sally McClean and Peter Millard Departments of geriatric medicine consist of two
course, die at any stage in their treatment, but it is
generally the case that the majority of patients
distinct forms of clinical activity: acute/rehabilitative and long stay care. These are organistionally distinct and have very different resource needs. Current hospital planning models, however, assume that patients all move through the system at the same
admitted to geriatric hospital are eventually rehabili-
tated and discharged. Nonetheless, the small
proportion who become long stay remain in hospital for months, or even years. Such patients may block
beds for long periods, consuming resources and
rate, thus ignoring this inherent heterogeneity in patient behaviour. We have developed a model
preventing admission of the sick elderly. In addition, the existence of such long stay patients means that simple methods of measuring performance which are generally in use, such as the crude turnover or
which allows for this.
The model may be used to estimate the average
mean length of stay for a patient, are no longer
numbers and lengths of stay for short-and long-stay patients and assess the effect of system changes such as converting long-stay to short-stay beds.
appropriate. Instead we must develop measures of throughput for a Geriatric Department which take
into account the fact that there are different streams
of patients flowing through the beds at different
The model has been implemented in a software package for Bed Occupancy, Management and
rates, determined by their current stage of care.
Planning (BOMPS) which uses daily bed occupancy census data. It is hoped that such an approach will
We have therefore developed a model which may be
used to analyse the pattern of bed occupancy of Geriatric Departments. This can help hospital staff to make policy decisions regarding the relative
provide more effective planning for the geriatric hospital seivice.
Background
advantages of policies such as increasing treatment rates versus decreasing the fraction of patients who
The proportion of elderly people in the population is increasing rapidly, while the relative proportion of
charge rate of acute care patients versus rehabilitating long-stay patients.
are retained as long-stay, or increasing the dis-
younger people participating in the worktorce is declining. The problem of caring for the frail or sick elderly is therefore one requiring urgent attention and careful planning, particularly in an environment of economic recession and government cutbacks.
The Model A model has been constructed in order to analyse the pattern of occupancy of hospital beds in Departments of Geriatric Medicine. This model was developed as a result of the empirical observation that the pattern of bed occupancy is best fitted by the two term mixed exponential distribution of the
In planning services for an aged population, the key factors are that e
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