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首页> 外文期刊>Manufacturing and service operations management >Bed Blocking in Hospitals Due to Scarce Capacity in Geriatric Institutions-Cost Minimization via Fluid Models
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Bed Blocking in Hospitals Due to Scarce Capacity in Geriatric Institutions-Cost Minimization via Fluid Models

机译：由于老年病院容量不足而造成的医院阻塞床-通过流体模型将成本降至最低

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Problem definition: This research focuses on elderly patients who have been hospitalized and are ready to be discharged, but they must remain in the hospital until a bed in a geriatric institution becomes available; these patients "block" a hospital bed. Bed blocking has become a challenge to healthcare operators because of its economic implications and the quality-of-life effect on patients. Indeed, hospital-delayed patients who do not have access to the most appropriate treatments (e.g., rehabilitation) prevent new admissions. Moreover, bed blocking is costly, because a hospital bed is more expensive to operate than a geriatric bed. We are thus motivated to model and analyze the flow of patients between hospitals and geriatric institutions to improve their joint operation. Academidpractical relevance: Practically, our joint modeling of hospital-institution is necessary to capture blocking effects. In contrast to previous research, we address an entire time-varying network, which enables an explicit consideration of blocking costs. Theoretically, our fluid model captures blocking without the need for reflection, which simplifies the analysis as well as the convergence proof of the corresponding stochastic model. Methodology: We develop a mathematical fluid model, which accounts for blocking, mortality, and readmission-all significant features of the discussed environment. Then, for bed allocation decisions, the fluid model and especially, its offered load counterpart turn out insightful and easy to implement. Results: The comparison between our fluid model, a twoyear data set from a hospital chain, and simulation results shows that our model is accurate and useful. Moreover, our analysis yields a dosed form expression for bed allocation decisions, which minimizes the sum of underage and overage costs. Solving for the optimal number of geriatric beds in our system shows that significant reductions in cost and waiting list length are achievable compared with current operations. Managerial implications: Our model can support healthcare managers in allocating geriatric beds to reduce operational costs. Moreover, our model facilitates three extensions: a periodic reallocation of beds, incorporation of setup costs into bed allocation decisions, and accommodating home care (or virtual hospitals) when feasible.
机译：问题定义：这项研究的重点是已经住院并且准备出院的老年患者，但是他们必须留在医院中，直到可以在老年病院找到床位为止;这些患者“阻塞”了医院的病床。阻塞床由于其经济意义和对患者的生活质量影响，已成为医疗保健操作人员的一项挑战。确实，无法获得最适当治疗（例如康复）的医院延迟患者阻止了新的入院治疗。而且，床阻塞是昂贵的，因为医院病床的操作比老年病床更昂贵。因此，我们有动力对医院和老年机构之间的患者流动进行建模和分析，以改善他们的联合手术。学术实践的相关性：实际上，我们需要对医院机构进行联合建模以捕获阻塞效应。与以前的研究相比，我们解决了整个时变网络，这使得可以明确考虑阻塞成本。从理论上讲，我们的流体模型无需反射即可捕获阻塞，从而简化了分析以及相应随机模型的收敛性证明。方法：我们开发了一个数学流体模型，该模型考虑了阻塞，死亡率和再入院问题-所讨论环境的所有重要特征。然后，对于床的分配决策，流体模型，尤其是它提供的负载对应物，将变得有见地且易于实施。结果：我们的流体模型，来自医院链的两年数据集和模拟结果之间的比较表明，我们的模型是准确且有用的。此外，我们的分析得出床分配决策的剂量形式表达式，从而最大程度地减少了未成年人和未成年人的费用总和。解决我们系统中老年病床的最佳数量表明，与当前运营相比，可以显着降低成本和等待清单的长度。对管理的影响：我们的模型可以支持医疗保健经理分配老年病床以降低运营成本。此外，我们的模型促进了三个扩展：定期重新分配床位，将设置成本合并到床位分配决策中以及在可行时容纳家庭护理（或虚拟医院）。

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