A Study on the Efficient Management of Long-term Inpatient Flow in a General Hospital

Kim, Chun Bae; Chae, Young Moon; Yu, Seung Hum; Oh, Hee Chul

Abstract

This study refers to the problem of long-term inpatient flow in a general hospital. In this study, a queueing simulation model was developed for the two departments in the hospital with a homogenous case mix and relatively many long-term inpatients in order to increase the tumover rate and hospital charges. Before the simulation run, the model was verified by the Kolmogorov-Smirmov test. The following results were generated by three alternative models of the special bed policies. 1. Alternative I: When long term inpatients were admitted to the wards belonging to departments A and B without transfer to other departments and special beds, the average turn-over rate decreased by 2-4% and the average hospital charges decreased by 70 million won. 2. Alternative II: When long-term inpatients were transferred to department C but the transfer of wards was determined by department C in order of clinical need, the average turnover rate increased by 4-13% but the average hospital charges decreased by 30 million won. This result was not greatly different from the present state. 3. Alternative III: When long-term inpatients were transferred to the special wards and department C simultaneously, the increase in the average turnover rate and hospital charges was equivalent to the increase of two beds in the special wards. When the special wards were allocated 16 beds, the average turnover rate of departments A and B increased by about 55% and 20% respectively. Also, the hospital charges increased by about 0.44 billion won. As a result, trasfer to department C and the use of 16 beds in the special wards for long-term inpatients of departments A and B is expected to maximize the hospital revenue. However, as the above special bed policy can not increase the turnover rate above 60%, there is a need for a more comprehensive policy to further increase the rate. The development of an elaborate model should include the number of long-term inpatients in all clinical departments, the special wards system or an increase of hospital beds to handle admission needs, and the resources of the hospital by department. When the alternative are evaluated, a cost-benefit analysis in addition to the turnover rate and the hospital charges should be considered.