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Canadian hospital admissions systems : a simulation approach Lim, Timothy Warren

Abstract

This study attempts to improve the delivery of health services by applying operations research techniques to hospital admission systems. Although this study applies to hospital admissions systems in general, the admission system of one ward of one hospital was chosen to be the central object in the study. A computer simulation model was formulated to examine the -results of various policies. In the model, the admission of patients is determined primarily by the scheduling of the operating theatre and secondarily by the availability of beds. The three standard priorities for hospital admissions (elective, urgent and emergent) are given separate considerations as would be the case in real life; because scheduling can be much more flexible for elective patients, while time must be set aside for emergent patients although the hospital has no advance information about them. The general results of this study led to two suggestions that would improve most existing admission systems. The first requires that the hospital set up a special class of patients, the "quickcall patients," who would be willing to be admitted for surgery on short notice. It was shown that this procedure significantly reduced the waiting time for elective surgery. The second requires that the hospital limit each physician to a fixed number of requests for elective surgery at any given time, so that the hospital need not keep extensive files. The model could be extended to examine (1) the sensitivity of the schedule to referral patients, (2) the higher utilization of the operating theatre and (3) waiting priority based on patient need and/or utility. In conclusion the simulation study indicated that these policies if implemented would significantly reduce the waiting time (29% in the model), and increase the hospital's effectiveness in assessing the order of admission for patients.

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