Reducing intraday patient wait times through just-in-time bed assignment

Abstract

Massachusetts General Hospital (MGH) is the oldest and largest hospital in New England as well as the original and largest teaching hospital of the Harvard Medical School. The neuroscience units experience patient flow issues similar to those observed throughout MGH, including high bed utilization and long intraday patient wait times. This project focuses on the neuroscience units as a microcosm of the hospital. MGH consistently operates near capacity. Patients from the emergency department, the perioperative environment, intensive care units (ICUs) and other sources compete for beds. The admitting department manages the bed assignment process across MGH. Assignments are often made without access to all relevant information, such as expected admission, surgery and discharge timing. As a result of common procedures, patients are frequently assigned to a bed before they are clinically ready to move. Our analysis reveals that suboptimal bed assignment and patient transfer processes are among the leading root causes of intraday patient delays. The primary objective of the project is to develop a bed assignment policy to reduce intraday patient wait times. The policy consists of a bed assignment algorithm and enabling bed management processes. To account for patient acuity, the algorithm segments patients by movement (e.g., ED-to-ICU). The target maximum wait for each segment is the acceptable wait length (AWL). The algorithm ranks patients based on their ready times and the AWLs, and assigns beds primarily on a just-in-time (JIT) basis. The enabling bed management processes include small-scale early discharge and early transfer interventions to better align the intraday timing of demand for inpatient beds with available capacity. A simulation of neuroscience patient flow is used to evaluate different approaches. The model shows that adoption of the JIT policy would increase the percentage of patients who experience bed waits within the AWL for all movement types. Predicted bed waits for patients who require ICU-level care would be 30 minutes or less for 90% of ED patients and 95% of OR patients (improvements from historical baselines of 44% and 91%, respectively). Predicted bed waits for transfers to floor beds would be two hours or less for 81% of ED patients and 93% of OR patients (improvements from historical baselines of 63% and 84%, respectively). The solution significantly reduces intraday patient wait times without a major increase in hospital capacity.