Policy, resources and practice: a palliative care ward

The Palliative Care Program undertook a commitment to assure direct admission of patients, terminally ill at home, to inpatient beds. This was accomplished by a priority policy which distinguished Home Care patients from those to be transferred. A simulation enabled us to define a rule for the control of transfers. It also made it possible to anticipate the impact of an increase in demand which might exceed the capacity of the ward and to estimate the size of ward expansion which might be necessary. In fact, the program adjusted to increased demand by modifying both practice and policy, always guided by the boundaries originally identified by the computer simulation. The calculated limits have corresponded remarkably to both the physical resources and to the staff's capacity for work.