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Predicting the Future: Using Simulation Modeling to Forecast Patient Flow on General Medicine Units
Vimal Mishra1, Shin-Ping Tu2, Joseph Heim3
1Division of Hospital Medicine, Medical Director of Telemedicine, Physician Informaticist, Virginia Commonwealth University Health System; Richmond, Virginia, USA. Vimal.Mishra@vcuhealth.org.
Journal of Hospital Medicine
|December 12, 2018
Summary
Discrete event simulation can optimize hospital operations. Adding a nursing unit improved system metrics, while aligning teams had mixed results. Strategic changes require careful analysis to avoid negative impacts.
Area of Science:
- Healthcare Operations Research
- Systems Engineering in Medicine
- Hospital Management
Background:
- Hospitals are complex adaptive systems requiring careful optimization.
- Discrete event simulation (DES) offers a method for predicting the impact of changes.
- Limited studies apply DES to general internal medicine (GIM) inpatient operations.
Purpose of the Study:
- To apply DES to model and evaluate strategic changes in GIM inpatient operations.
- To predict the impact of specific operational adjustments on key hospital metrics.
- To inform decision-making for optimizing GIM inpatient unit performance.
Main Methods:
- Constructed a DES model using administrative data, time-motion study data, and expert workflow opinions.
- Modeled four scenarios: aligning medical teams with nursing units, adding hospitalist teams, adding nursing units, and combining both with increased volume.
- Evaluated the impact on hospital operational metrics such as patient throughput and team performance.
Main Results:
- Aligning medical teams improved metrics for aligned teams but negatively impacted unaligned teams.
- Adding a hospitalist team showed minimal benefit; adding a nursing unit improved system metrics.
- A combination of hospitalist and nursing unit additions was necessary to maintain operational metrics under higher patient volumes.
Conclusions:
- Simulation modeling provides valuable data on the implications of strategic changes in GIM inpatient settings.
- DES can help healthcare leaders make informed decisions, minimizing unintended consequences.
- Investing in simulation analysis is recommended for strategic planning in hospital operations.
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