Access to Long-Term Care: The True Cause of Hospital Congestion?

• 成果类型: Article
• 署名作者: Patrick, Jonathan
• 署名单位: University of Ottawa
• 刊物名称: PRODUCTION AND OPERATIONS MANAGEMENT
• ISSN/ISSBN: 1059-1478
• DOI: 10.1111/j.1937-5956.2011.01229.x
• 发表日期: 2011
• 页码: 347-358
• 关键词: Health care; long-term care; Markov decision processes; Scheduling; simulation health care

摘要

Much attention has been paid to lengthy wait times in emergency departments (EDs) and much research has sought to improve ED performance. However, ED congestion is often caused by the inability to move patients into the wards while the wards in turn are often congested primarily due to patients waiting for a bed in a long-term care (LTC) facility. The scheduling of clients to LTC is a complex problem that is compounded by the variety of LTC beds (different facilities and room accommodations), the presence of client choice and the competing demands of the hospital and community populations. We present a Markov decision process (MDP) model that determines the required access in order for the census of patients waiting for LTC in the hospitals to remain below a given threshold. We further present a simulation model that incorporates both hospital and community demand for LTC in order to predict the impact of implementing the policy derived from the MDP on the community client wait times and to aid in capacity planning for the future. We test the MDP policy vs. current practice as well as against a number of other proposed policy changes.