CRHE

Bed Capacity Planning and Smoothing Using Computer

Simulation on the OR Master Schedule

Michael W. CarterCentre for Healthcare Operations

Mechanical and Industrial EngineeringUniversity of Toronto

Brief introduction Hospital bed capacity planning Operating room Master Surgery Scheduling

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Outline

The Importance of Health Care

Health care is North Americas largest single industry.

Estimated total spending in Canada was $219 billion (CN) in 2015. ($2.9 trillion in the US)

In Canada, in 2013, $4,569 US per person was spent on health care compared to $9,086 in US

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$ pe

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son

$ Bi

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sTotal $ $/Person

Chart1

22.3910

26.31059

30.81225

341342

36.71435

39.81542

43.31660

46.81769

511902

56.12056

612203

66.32365

69.82461

71.62495

73.12520

74.12528

74.72522

78.42623

83.72778

89.92957

97.93207.0433581092

106.33451.2043776781

1143663.9613717129

1233899.7872285683

130.34114.4419250561

1414355

1514630

1604866

1725162

1825398

1935659

1995803

2055902

Total $

$/Person

$ Billions

$ per person

Sheet1

Total $$/Person

8022.3910

8126.31059

8230.81225

83341342

8436.71435

8539.81542

8643.31660

8746.81769

88511902

8956.12056

90612203

9166.32365

9269.82461

9371.62495

9473.12520

9574.12528

9674.72522

9778.42623

9883.72778

9989.92957

0097.93207.0433581092

01106.33451.2043776781

021143663.9613717129

031233899.7872285683

04130.34114.4419250561

051414355

061514630

071604866

081725162

091825398

101935659

111995803

122055902

132095988

142166000

152196105

Sheet2

International Trends

OECD web site: www.oecd.org Dec. 2015

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20.0

80 82 84 86 88 90 92 94 96 98 '00 '02 '04 '06 08 10 12 14

Health Spending as a % GDP

US

Canada

France

Germany

UK

Netherlands

Japan

Mexico

Belgium

CRHE Canadian Medicare (very brief)

Providers are private. Govt pays for services (like US Medicare) Covered if:

Medically necessary Done in a hospital Done by a doctor

1990 Internationally recognized leader 2000 We had slipped significantly 2008 Major funding increases improving 2012 Major funding challenges!

4 10 9 5 5 7 7 3 2 1 11 Quality Care

Effective Care Safe

Care Coordinated

Care

Patient-Centered Care

2 9 8 7 5 4 11 10 3 1 5

4 7 9 6 5 2 11 10 8 1 3

3 10 2 6 7 9 11 5 4 1 7

4 8 9 10 5 2 7 11 3 1 6

5 8 10 7 3 6 11 9 2 1 4

Access

Cost-Related Problem

Timeliness of Care

8 9 11 2 4 7 6 4 2 1 9

9 5 10 4 8 6 3 1 7 1 11

6 11 10 4 2 7 8 9 1 3 5

Efficiency 4 10 8 9 7 3 4 2 6 1 11

Equity 5 9 7 4 8 10 6 1 2 2 11

Healthy Lives 4 8 1 7 5 9 6 2 3 10 11 Health Expenditures/Capita, 2011**

$3,800

$4,522

$4,118

$4,495

$5,099

$3,182

$5,669

$3,925

$5,643

$3,405

$8,508

COUNTRY RANKINGS

Top 2*

Middle

Bottom 2*

OVERALL RANKING (2013)

AUS CAN FRA GER NETH NZ NOR SWE SWIZ UK US

Notes: * Includes ties. ** Expenditures shown in $US PPP (purchasing power parity); Australian $ data are from 2010. Source: Calculated by The Commonwealth Fund based on 2011 International Health Policy Survey of Sicker Adults; 2012 International Health Policy Survey of Primary Care Physicians; 2013 International Health Policy Survey; Commonwealth Fund National Scorecard 2011; World Health Organization; and Organization for Economic Cooperation and Development, OECD Health Data, 2013 (Paris: OECD, Nov. 2013).

Commonwealth Report 2014

COUNTRY RANKINGS

(4109557732111Quality CareEffective Care Safe Care Coordinated CarePatient-Centered Care29875411103154796521110813310267911541748910527113165810736119214AccessCost-Related ProblemTimeliness of Care89112476421995104863171116111042789135Efficiency4108973426111Equity5974810612211Healthy Lives4817596231011Health Expenditures/Capita, 2011**$3,800$4,522$4,118$4,495$5,099$3,182$5,669$3,925$5,643$3,405$8,508)Top 2* Middle Bottom 2*

OVERALL RANKING (2013)

AUSCANFRAGERNETHNZ NORSWESWIZ UK US

Notes: * Includes ties. ** Expenditures shown in $US PPP (purchasing power parity); Australian $ data are from 2010.

Source: Calculated by The Commonwealth Fund based on 2011 International Health Policy Survey of Sicker Adults; 2012 International Health Policy Survey of Primary Care Physicians; 2013 International Health

Policy Survey; Commonwealth Fund National Scorecard 2011; World Health Organization; and Organization for Economic Cooperation and Development, OECD Health Data, 2013 (Paris: OECD, Nov. 2013).

Background

Master Surgical Schedule Revised every 6-12 months Block booking OR time Major driver of resource utilization downstream

(PACU, ICU, beds) and upstream (wait lists). How can you manage the volumes? I will discuss two applications.

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CRHE

Tian Mu Liu and Michael Carter

Hospital Bed Capacity Planning

CRHEDevelopment of Bed Allocation Model

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Model Objective To estimate the number of beds a hospital needs during a typical week in order to provide a given level of service

We constructed a prototype: In-patient groups are categorized by: admission category,

provider service, bed group A typical week includes 21 shifts (seven days a week and

three shifts a day)

CRHEModel Overview

Use one year of historical data Model surgical patients based on a typical full week

OR schedule Model medical/emergent/urgent patients based on

random historical arrivals We do not consider ward capacity; we tell you how

many beds you need in each service We simulate several weeks, and find a range

(confidence intervals) Separate LOS: ED (admitted), ICU, ward, ALC

CRHEED Bed Demand (Regina General)

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Admitted patients Bed Blockers: 10-17 Bed demand peaks on weekday evenings (3-4 more)

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CRHEICU Bed Demand

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Number of required SCU beds range: 55-63 Bed demand is relatively consistent throughout a week

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CRHEWard Bed Demand

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Ward beds range: 344-370 Bed demand peaks on Thursday evening

353 347 345 344 348 351354 359 361

363 363 365 367 367 370 370 370 370 366 360 357

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CRHEAverage Demand by Service

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1 Infants2 Pregnancy & Childbirth3 Pediatrics4 Mental Health5 Surgical6 Medical

CRHE

Balancing Demand

By swapping blocks for a few surgeons, we can dramatically reduce the peaks in bed demand

Tian has created an automated procedure Surgeons can be fixed in place

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CRHESurgical Ward and ICU beds

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CRHERevised OR schedule

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Revised Shift Monday Tuesday Wednesday Thursday Friday

OR 1 MorningPooler, Stephen Duane Meiers, Suzanne Tse, Edward T W Kaban, Gordie K Akinbiyi, Amos A

AfternoonCuddington, Gordon W