The decrease of ED patient boarding by implementing a stock management policy in hospital admissions

The presence of congestion is a common scenario in tertiary-level hospitals worldwide. Current research suggests that an increase in hospital bed capacity is not a long-term solution given that patient demand adapts to added capacity. Recent literature suggests the need for the implementation of a policy of inter-hospital transfers to divert patients to outpatient priority services or home care. This policy has proven to be effective in reducing ED boarding without compromising patient safety. However, determining the required number of patients to be admitted is key. The dynamic nature of hospital bed availability and discharges requires an admission process able to be in synchrony with those variations. A mismatch between patient demand and hospital admissions will result in either ED boarding or idle capacity. The purpose of this paper is to introduce a methodology to support the process of hospital admissions by providing as an input a threshold for the number of patients to be admitted. The methodology is tested using a system dynamics model that replicates one year of operations of a tertiary-level hospital. The simulations reveal the potential of the methodology to decrease the ED inpatient boarding rate as well as ED and hospital length of stay.