Simulation of home-hospital impacts on crowding – FM implications

Abstract

Purpose

This study aims to evaluate home-hospital implications for facility management (FM) and, in particular, ED crowding. Home-hospital programs, in which select patients receive hospital-level care at home, can extend hospital facility capacity. Emergency department (ED) crowding, a sensitive hospital capacity indicator, is associated with unsafe operations and reduced quality of care.

Design/methodology/approach

The impact of a home-hospital program on crowding was analyzed with a discrete-event simulation model using one month of historical data from a case hospital. Time ED patients waited for inpatient beds was the primary endpoint. Five scenarios with different levels of patient suitability for home-hospital were each run 30 times. Differences were evaluated using paired t-tests.

Findings

Implementing home-hospital reduced ED crowding by up to 3 per cent. Additionally, the simulation yielded insights regarding advantages and limitations of various home-hospital arrangements, suggested which hospital types may be the best candidates for home-hospital and highlighted the role of bed-cleaning turnaround times and environmental services staffing schedules in operations.

Research limitations/implications

This research examined home-hospital and crowding at one hospital. Developing a model that accounts for all hospital types requires significant data and many hospital partnerships but could allow for more informed decisions regarding implementation of such programs.

Social implications

This research has implications for ensuring access to ED care, an important source of acute care generally and particularly for the underserved.

Originality/value

This research systematically evaluates home-hospital’s impact on ED crowding. Simulation modeling resulted in analytical results and allowed for evaluation of what-if scenarios providing recommendations for hospital FMs on their role in decreasing ED boarding.

Citation

Fard, J., Roper, K.O. and Hess, J. (2016), "Simulation of home-hospital impacts on crowding – FM implications", Facilities, Vol. 34 No. 13/14, pp. 748-765. https://doi.org/10.1108/F-07-2015-0048