A Simulation Model to Evaluate the Interaction between Acute, Rehabilitation, Long Stay Care and the Community

Abstract

The flow of patients through geriatric hospitals has been previously described in terms of acute (short stay), rehabilitation (medium stay), and long stay states where the bed occupancy at a census point is modelled by a mixed exponential model using BOMPS (Bed Occupancy Modelling and Planning System). In this a patient is initially admitted to acute care. The majority of the patients are discharged within a few days into their own homes or through death. The rest are converted into medium stay patients where they could stay for a few months and thereafter either leave the system to support homes or die or move on to a long stay compartment where they could stay until they die. Patients released to the community from the acute and the rehabilitation compartments may be re-admitted into the geriatric department. The flow model forecasts the average length of stay as well as the average number of patients in each state, but there are certain limitations. In this paper we consider the problem as a queuing system to assess the flow of patients within a geriatric department and community homes, and to allow a greater understanding of bed requirements and effective utilisation of resources. Extensive sensitivity analysis is conducted to demonstrate the interaction between the different streams of flow inside a geriatric department and the different destinations of the patients after discharge.