Managing Hospital Inpatient Bed Capacity Through Partitioning Care into Focused Wings
Managing Hospital Inpatient Bed Capacity Through Partitioning Care into Focused Wings
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DOI：
10.1287/msom.2014.0516
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发表时间：
2015-03-01
影响因子：
6.3
通讯作者：
Meltzer, David O.
中科院分区：
文献类型：
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作者：
Best, Thomas J.;Sandikci, Burhaneddin;Meltzer, David O.
我们从医院管理员的角度考虑将护理类型划分为不同的翼，他希望优化使用固定数量的床位，这些床位为不同的护理类型提供服务。医院管理人员决定要形成的侧翼数量、要分配给每个侧翼的床位数量，以及要分配给每个侧翼的护理类型集，以使医院的总效用最大化。管理员面临着内在的权衡，既要形成巨大的羽翼来汇集需求和床位容量，又要形成专门的羽翼来专注于狭窄的护理类型。专用翼不仅提供集中护理的优势，还允许保护高实用护理类型的床位。我们为机翼编队决策提供了一个优化模型，并在该模型中内生地解决了焦点的优势。使用来自美国一家大型城市教学医院的数据和国家数据库，我们报告了一些管理见解。特别是，随着所有护理类型的总体需求增加，形成了为更高效用类型预留更多床位的翅膀，这导致了更高的整体医院效用，但类型之间也存在一些差异，例如一些人住院的机会增加，另一些人的机会减少。此外，随着医院被一分为二，总床位占有率下降。然而，如果获得了足够的关注，与重点护理相关的较短的住院时间可能会增加患者的总体吞吐量。我们还观察到，当患者愿意等待更长时间入院时，医院往往会形成更多的翅膀。这意味着，等待时间更长的医院可以形成更专业化的翅膀，从而受益于集中护理，而无法等待的医院往往会形成更少的翅膀，选择汇集需求和床位容量。
We consider the partitioning of care types into wings from the perspective of a hospital administrator who wishes to optimize the use of a fixed number of beds that provide services for heterogeneous care types. The hospital administrator decides on the number of wings to form, the number of beds to allocate to each wing, and the set of care types to assign to each wing to maximize the total utility to the hospital. The administrator faces an inherent trade-off between forming large wings to pool demand and bed capacity, and forming specialized wings to focus on narrow ranges of care types. Specialized wings not only provide advantages from focused care but also allow the protection of beds for high-utility care types. We provide an optimization model for the wing formation decision and address the advantages of focus endogenously in our model. Using data from a large urban teaching hospital in the United States along with a national database, we report on a number of managerial insights. In particular, as the overall demand increases across all care types, wings are formed to reserve more beds for higher-utility types, which leads to higher overall hospital utility but also some disparity across types, such as increased hospital access for some and decreased access for others. Furthermore, overall bed occupancy decreases as the hospital is split into wings. However, if sufficient focus is attained, shorter lengths-of-stay associated with focused care may increase overall patient throughput. We also observe that when patients are willing to wait longer for admission, the hospital tends to form more wings. This implies that hospitals that garner longer waits can form more specialized wings and thereby benefit from focused care, whereas hospitals that cannot will tend to form fewer, if any, wings, choosing to pool demand and bed capacity.