Flexible bed allocations for hospital wards

Abstract

Flexibility in the usage of clinical beds is considered to be a key element to efficiently organize critical capacity. However, full flexibility can have some major drawbacks as large systems are more difficult to manage, lack effective care delivery due to absence of focus and require multi-skilled medical teams. In this paper, we identify practical guidelines on how beds should be allocated to provide both flexibility and utilize specialization. Specifically, small scale systems can often benefit from full flexibility. Threshold type of control is then effective to prioritize patient types and to cope with patients having diverse lengths of stay. For large scale systems, we assert that a little flexibility is generally sufficient to take advantage of most of the economies of scale. Bed reservation (earmarking) or, equivalently, organizing a shared ward of overflow, then performs well. The theoretical models and guidelines are illustrated with numerical examples. Moreover, we address a key question stemming from practice: how to distribute a fixed number of hospital beds over the different units?

Keywords: Bed pooling; Clinical capacity; Earmarking; Flexible bed allocation; Optimization; Queueing model.

Fig. 1

Efficiency frontier in case of specialized care at one ward

Fig. 2

Efficiency frontier for two wards with different ALOS

Fig. 3

Relative difference in average costs for simple merging (a), earmarking policy (b) and threshold policy (c) compared to the average costs for the optimal policy

Fig. 4

Blocking probability as a function of the number of flexible beds