title: A Simulated Level Loading of Supply and Demand for Beds in a Tertiary Care Children's Hospital Reduces Overall Bed Requirements.
abstract: BACKGROUND
  Anticipating throughput and allocating resources effectively in children's hospitals have unique challenges relative to adult inpatient centers. The seasonal and daily variation can be difficult to anticipate in terms of impact and creating plans for adequate preparation. Discrete event simulation methodology can be helpful in determining appropriate allocation of resources and has been increasingly appropriated in health care from industry.
  
  
  METHODS
  A representative sample set was abstracted from the Cohen Children's Medical Center census tracking system to describe the present state. A larger data set was used to determine the appropriate level load. The total work performed each hour from 8 AM to 8 PM was evaluated against the level load plan of 11.5%. During the initial hours of the working period when the total work was low, more discharges were added. For each discharge added, an equal quantity of discharges was subtracted from the later hours of the day to bring the total work below 11.5% for each hour. Once the simulated state discharges were determined, a new aggregate bed supply line was created. These values were then added to the original visualization to show improvement.
  
  
  RESULTS
  Our analysis suggests that a large part of the discharge/transfer activity and bed demand activity occurs in the pediatric intensive care unit in a roughly 4- to 5-hour window. Our simulation analysis suggests that level loading of this resource-intensive activity period has a potential to reduce bed occupancy, increase bed availability in peak bed demand times, and improve efficiency and throughput throughout the hospital.
  
  
  CONCLUSIONS
  Discrete event simulation can be an effective tool for pediatric inpatient centers to determine appropriate allocation of resources to enhance patient safety and throughput without significant, costly expansion of bed capacity.
authors.affiliation: Divisions of Pediatric Critical Care Medicine (Dr Gangadharan) and Healthcare Quality (Mr Belpanno), Cohen Children's Medical Center, North Shore Long Island Jewish Health System, New Hyde Park, New York.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Gangadharan
authors.forename: Brian
authors.initials: B
authors.lastname: Belpanno
mesh_terms: D001509:Bed Occupancy / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D008962:Models, Theoretical; D010351:Patient Discharge / Q000706:statistics & numerical data*; D063128:Tertiary Health Care / Q000706:statistics & numerical data*