Design and Analysis of Hospital Admission Control for Operational Effectiveness

Design and Analysis of Hospital Admission Control for Operational Effectiveness

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Article ID: iaor201113093
Volume: 20
Issue: 3
Start Page Number: 359
End Page Number: 374
Publication Date: May 2011
Journal: Production and Operations Management
Authors: , ,
Keywords: quality & reliability, control, queues: applications, programming: markov decision
Abstract:

Variability in hospital occupancy negatively impacts the cost and quality of patient care delivery through increased emergency department (ED) congestion, emergency blockages and diversions, elective cancelations, backlogs in ancillary services, overstaffing, and understaffing. Controlling inpatient admissions can effectively reduce variability in hospital occupancy to mitigate these problems. Currently there are two major gateways for admission to a hospital: the ED and scheduled elective admission. Unfortunately, in highly utilized hospitals, excessive wait times make the scheduled gateway undesirable or infeasible for a subset of patients and doctors. As a result, this group often uses the ED gateway as a means to gain admission to the hospital. To better serve these patients and improve overall hospital functioning, we propose creating a third gateway: an expedited patient care queue. We first characterize an optimal admission threshold policy using controls on the scheduled and expedited gateways for a new Markov decision process model. We then present a practical policy based on insight from the analytical model that yields reduced emergency blockages, cancelations, and off-unit census via simulation based on historical hospital data.

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