Abstract
Early bed assignments of elective surgical patients can be a useful planning tool for hospital staff; they provide certainty in patient placement and allow nursing staff to prepare for patients’ arrivals to the unit. However, given the variability in the surgical schedule, they can also result in timing mismatches—beds remain empty while their assigned patients are still in surgery, while other ready-to-move patients are waiting for their beds to become available. In this study, we used data from four surgical units in a large academic medical center to build a discrete-event simulation with which we show how a Just-In-Time (JIT) bed assignment, in which ready-to-move patients are assigned to ready-beds, would decrease bed idle time and increase access to general care beds for all surgical patients. Additionally, our simulation demonstrates the potential synergistic effects of combining the JIT assignment policy with a strategy that co-locates short-stay surgical patients out of inpatient beds, increasing the bed supply. The simulation results motivated hospital leadership to implement both strategies across these four surgical inpatient units in early 2017. In the several months post-implementation, the average patient wait time decreased 25.0% overall, driven by decreases of 32.9% for ED-to-floor transfers (from 3.66 to 2.45 hours on average) and 37.4% for PACU-to-floor transfers (from 2.36 to 1.48 hours), the two major sources of admissions to the surgical floors, without adding additional capacity.
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29 March 2024
The original version of this article was updated to include the missing ESM file.
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Acknowledgements
The authors thank Ann L. Prestipino and Peter L. Slavin, MD (Senior Vice President of MGH and President of MGH, respectively, at the time of this work) for their continuous support throughout this process. We are grateful to the nursing directors from the units who participated and contributed to the implementation of the strategy, and to Gianna Wilkins from Process Improvement for helping to map and document the new processes during implementation. Finally, we thank the editor and two anonymous reviewers for detailed feedback which has improved the completeness of the work herein.
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Braaksma, A., Copenhaver, M.S., Zenteno, A.C. et al. Evaluation and implementation of a Just-In-Time bed-assignment strategy to reduce wait times for surgical inpatients. Health Care Manag Sci 26, 501–515 (2023). https://doi.org/10.1007/s10729-023-09638-3
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DOI: https://doi.org/10.1007/s10729-023-09638-3