Seven-Day versus Five-Day Flow-Capacity

Dodds, Simon (2015) Seven-Day versus Five-Day Flow-Capacity. Journal of Improvement Science, 24. pp. 1-30. ISSN 2054-6629.

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Studies show that, for emergency presentations, there is a positive correlation between admission at weekends and poorer outcomes as measured by higher mortality. Data from a typical medium sized hospital reveals that the A&E 4-hour breach rates show a 7-day cycle, as do the emergency admissions and hospital discharges. The combined effect is a rising hospital bed occupancy over the weekend which, if beds are limited, creates an admission bottleneck, admission delays, potential harm for the most vulnerable patients and stress for staff. A stream-aligned discrete event simulation (DES) model was developed and verified using actual data from the hospital. This was then used to predict the impact of switching from a 5-day to a 7-day discharge flow-capacity policy. The effect was a reduction in variation of hospital bed occupancy that released sufficient space-capacity (beds) to eliminate the weekend admission bottleneck. Just smoothing the decision making and discharge flow-capacity across the week provided the necessary flow-resilience to significantly reduce admission delays and 4-hour breaches in A&E. The cost of this policy change is predicted to be neutral. We conclude that developing system-wide flow design capability in the NHS is a potentially high-benefit strategy for improving safety, flow, quality experienced by both patients and staff, and NHS productivity.

Item Type: Article
Subjects: WO Surgery
Divisions: Planned IP Care > General Surgery
Depositing User: Mr Philip O'Reilly
Date Deposited: 16 Oct 2015 15:14
Last Modified: 16 Oct 2015 15:14

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