Simulating Acute Bed Capacity – 7 days a week NHS IMAS Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013 More information about this event can be found at http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx

1. Simulating Acute Bed Capacity
- 7 days a week
Introduction
Improving emergency care
is complex and depends on
a range of factors including:
• Daily and hourly variations
in patient demand
• Varying lengths of
hospital stay
• Discharge practices
• Availability of health and
social care services pre
and post-discharge
Project Aim
The aim of our project was to
bring together the available
data and improvement
evidence into a simulation
model which could be used
to demonstrate best practice
and to allow hospitals to test
their own solutions and enter
their own data to understand
which improvement might
be most effective for them.
Understanding the
impact of changing to
7 day working on the
system is challenging,
and stakeholders want to
understand the resource
implications for acute beds.
Partnership
Russell Emeny NHS IMAS
Fiona Lindsay SIMUL8 Corporation
Claire Cordeaux SIMUL8 Corporation
The project has been a
partnership between the NHS
IMAS Emergency Care team
(ECIST) and the Cumberland
Initiative (an academic,
industry, NHS partnership)
with specific input from
Professor Sally Brailsford at
Southampton University
and Professor Terry Young at
Brunel. It has been informed
by an in depth study of the
evidence and based on the
field work of the NHS IMAS
team. SIMUL8 Corporation
has provided the modelling
expertise and software to
develop the simulation.
Simulation
Simulation is an accurate
computer model that
looks and acts just like a
real life process, allowing
experimentation with
changes to a system,
without taking the risk of
making the changes in real
life. Because it can manage
the complexity of a system
like health and social care,
including variation in arrivals,
patient types, lengths of
stay, staff and bed capacities
and costs, simulation can
provide the evidence needed
for decisions about which
intervention is the most cost
effective and can improve
the flow and decrease
bottlenecks in the system.
The Acute Bed Model
The simulation model represents patients arriving at hospital through
an emergency care route and needing to be admitted. Patients
are admitted to a bed for a length of stay and are then discharged.
Admissions are sent directly to a bed and length of stay is simulated
using a distribution based on midnight stays depending on the hour
of the day and the day of the week that the patient was admitted.
As with the arrival data the simulation has been populated with
default LOS data and this can also be adjusted to reflect local data.
Results show:
• Bed occupancy as a percentage and numbers of beds in use
• Time spent waiting for a bed
Improvement Scenarios:
• GP referrals arriving earlier in the day
• Effective ambulatory care
• Increasing proportion of patients who only stay 2 nights
• Shifting the hours of discharge earlier in the day
• Reducing the length of stay for patients over 75 who stay 14 nights
7 Day Working
All scenarios function 7 days a week in this simulation model. We also
simulated the impact of having a Monday profile of length of stay
every day of the week. We assumed that Monday’s profile, being the
furthest from the weekend might give the best representation of this
“what if?” scenario. What we found was the bed utilization actually
increased and there were longer waits for a bed. Why? Our explanation
is that simply extending current practices from five to seven days
may paradoxically increase length of stay. This is because Friday
creates a ‘breakpoint’ that clinical teams work to and without such
a psychological deadline, pressure to discharge may be reduced.
Two Conclusions
1. 7 day working defines all our
emergency care data and
simply using historic data to
model impacts may not provide
us with the evidence we need
to drive forward change. We
need to carefully consider
what is likely to happen when
access to care and clinical
judgement, rather than the
weekend, drive emergency
arrivals and lengths of stay.
2. 7 day working in itself will
not derive the expected
benefits if other improvements
are not implemented