Design and Analysis of Hospital Admission Control for Operational Effectiveness
2011, Production and Operations Management
Jonathan E. Helm, Shervin AhmadBeygi, Mark P. Van Oyen
Variability in hospital occupancy negatively impacts the cost and quality of patient
care delivery through increased Emergency Department (ED) congestion, emergency blockages
and diversions, elective cancelations, backlogs in ancillary services, overstaffing and understaffing.
Controlling inpatient admissions can effectively reduce variability in hospital occupancy to miti
gate these problems. Currently there are two major gateways for admission to a hospital: the ED
and scheduled elective admission. Unfortunately, in high demand hospitals, excessive wait times
make the scheduled gateway undesirable or infeasible for a subset of patients and doctors. As a
result, this group often uses the ED gateway as a means to gain admission to the hospital. To
better serve these patients and improve overall hospital functioning, we propose creating a third
gateway: an expedited patient care queue. We first characterize an optimal admission thresh
old policy using controls on the scheduled and expedited gateways for a new Markov Decision
Process model. We then present a practical policy based on insight from the analytical model
that yields reduced emergency blockages, cancelations and off-unit census via simulation based
on historical hospital data.
Helm, Jonathan E., Shervin AhmadBeygi, and Mark P. Van Oyen (2011), "Design and Analysis of Hospital Admission Control for Operational Effectiveness," Production and Operations Management, Vol. 20, No. 2, pp. 359-374.
Health Care Operations, Patient Flow Modeling, Markov Decision Processes, Admission Control.