Addressing the variation of post-surgical inpatient census with computer simulation.
OBJECTIVE
This study describes the development of a Discrete Event Simulation (DES) of a large pediatric perioperative department, and its use to compare the effectiveness of increasing the number of post-surgical inpatient beds vs. implementing a new discharge strategy on the proportion of patients admitted to the surgical unit to recover.


METHODS
A DES of the system was developed and simulated data were compared with 1 year of inpatient data to establish baseline validity. Ten years of simulated data generated by the baseline simulation (control) was compared to 10 years of simulated data generated by the simulation for the experimental scenarios. Outcome and validation measures include percentage of patients recovering in post-surgical beds vs. "off floor" in medical beds, and daily census of inpatient volumes.


RESULTS
The proportion of patients admitted to the surgical inpatient unit rose from 79.0% (95% CI, 77.9-80.1%) to 89.4% (95% CI, 88.7-90.0%) in the discharge strategy scenario, and to 94.2% (95% CI, 93.5-95.0%) in the additional bed scenario. The daily mean number of patients admitted to medical beds fell from 9.3 ± 5.9 (mean ± SD) to 4.9 ± 4.5 in the discharge scenario, and to 2.4 ± 3.2 in the additional bed scenario.


CONCLUSIONS
Every hospital is tasked with placing the right patient in the right bed at the right time. Appropriately validated DES models can provide important insight into system dynamics. No significant variation was found between the baseline simulation and real-world data. This allows us to draw conclusions about the ramifications of changes to system capacity or discharge policy, thus meeting desired system performance measures.
The Children's Hospital of Philadelphia, Office of Patient Safety and Quality, AE25H, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA, dayt@email.chop.edu.
Theodore Eugene
TE
Day
Albert
A
Chi
Matthew Harris
MH
Rutberg
Ashley J
AJ
Zahm
Victoria M
VM
Otarola
Jeffrey M
JM
Feldman
Caroline A
CA
Pasquariello
D019352:Censuses; D002648:Child; D003198:Computer Simulation; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D015233:Models, Statistical; D010372:Pediatrics; D013503:Surgery Department, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*