What Data Drives this ModelBack Up Slides

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What Data Drives this ModelWhat Data Drives this Model?

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* Includes only admits to nursing units in study

Data Collection Period: 1 Jan 2010 to 31 Dec 2011Source: Admission/Disposition/Transfer Report

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Data Collection / Data Input• What’s “Under the Hood?”

ARRIVAL DATA – Average Admissions Per Day

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• One of Many Probability Distributions:Samples of Admission Arrival Cycles

Sunday Admissions

Monday Admissions

2.9%2.3%2.0%1.9%2.1%4.9%2.8%3.5%4.6%5.3%5.3%5.1%6.2%5.4%5.4%5.6%5.3%5.5%5.0%4.8%4.2%3.6%3.4%2.7%

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2.6%1.8%1.4%1.3%2.2%

9.0%4.1%4.6%5.4%6.0%5.6%5.7%5.9%5.1%5.6%5.3%5.3%4.6%4.5%3.3%3.5%2.9%2.4%2.1%0.0%

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Data Collection / Data Input

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UNIT NAME % ARRIVALSHOSPITALISTS 24.79%PRIM CARE 20.49%CARDIO 11.75%GEN SURG 11.73%ORTHO 9.19%TRAUMA CRIT CARE SURG 5.11%VASCULAR 4.24%STROKE 3.92%CARDIAC SURG 3.06%ONC 3.05%CRITICAL CARE 1.63%CARDIOTHORACIC SURG 1.06%

Data Collection / Data Input• Percent of Admissions by Service Line

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LOC CapacityUnit_S_10A_ONC 22Unit_S_10B_PCAR 10Unit_W_05 26Unit_W_09 27Unit_W_10 28Unit_W_11 28Unit_E_07 16Unit_W_08 27Unit_W_12 27Unit_M_07PCU 12Unit_M_07PCU2 8Unit_M_08PCU 20Unit_M_09PCU 20Unit_M_10PCU 20Unit_S_07PCU_S_07SW 21Unit_S_08PCU_S_08SW 25Unit_S_09PCU_S_09SW 25Unit_M_06ICU 12Unit_M_08ICU 12Unit_M_09ICU 12Unit_M_10ICU 12Unit_S_06ICU 11Unit_S_07ICU 12Unit_S_09TSU 10

Data Collection / Data Input• Bed Capacity by

Nursing Unit in Study

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HOSP

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ISTS

PRIM

 CAR

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CARD

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GEN

 SURG

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TRAU

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IT CAR

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VASC

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STRO

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IAC SU

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CRITICAL

 CAR

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CARD

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CIC 

SURG

ACUITY% 

ARRIVAL% 

ARRIVAL% 

ARRIVAL% 

ARRIVAL% 

ARRIVAL% 

ARRIVAL% 

ARRIVAL% 

ARRIVAL% 

ARRIVAL% 

ARRIVAL% 

ARRIVAL% 

ARRIVAL

M/S Level 1 29.19% 26.76% 0.07% 57.26% 95.42% 21.27% 8.93% 4.66% 0.39% 94.03% 15.29% 3.66%

PCU Level 2 59.64% 61.97% 70.35% 32.08% 3.50% 51.12% 56.47% 74.74% 37.24% 4.12% 30.32% 57.46%

ICU Level 3 11.17% 11.27% 29.58% 10.66% 1.08% 27.60% 34.60% 20.61% 62.36% 1.85% 54.39% 38.87%

Data Collection / Data Input• Percent Admit by Acuity by Service

and How Initial Acuity Attributes are Assigned

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Mean = 2.89 days

Data Collection / Data Input• Example of a Fitted Distribution for Length of

Stay: Service = Stroke Patients,Acuity Level = ICU, Transfer Status = 1st

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Data Collection / Data Input• LOS Accounts for Variation Between

– 1) Admitting Service – 2) Acuity Level and – 3) Number of Transfers between Units

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1ST ROUTING 2ND ‐ 4TH ROUTING 5TH ‐ 8TH ROUTING

ServiceACUITY LEVEL 1

ACUITY LEVEL 2

ACUITY LEVEL 3

ACUITY LEVEL 1

ACUITY LEVEL 2

ACUITY LEVEL 3

ACUITY LEVEL 1

ACUITY LEVEL 2

ACUITY LEVEL 3

HOSPITALISTS B(1.08, 16.7, 0., 72.1) B(0.992, 10., 0., 49.8)2.96*(1./((1./U(0.5,0.5))‐1.))**(1./1.65) B(1.24, 83.1, 0., 269) B(1.37, 68.1, 0., 215)

2.83*(1./((1./U(0.5,0.5))‐1.))**(1./1.87) P6(1.01, 4.34, 22.2) P6(1.01, 4.34, 22.2) P6(1.01, 4.34, 22.2)

PRIM_CARE ER(4.42, 1.) W(1.06, 4.36) G(1.01, 4.66) B(1.04, 28.5, 0., 96.3) B(1.19, 21.2, 0., 72.4)2.61*(1./((1./U(0.5,0.5))‐1.))**(1./1.77) P6(1.01, 4.34, 22.2) P6(1.01, 4.34, 22.2) P6(1.01, 4.34, 22.2)

CARDIO B(1.28, 20.9, 0., 50.7) B(1.28, 20.9, 0., 50.7) B(1.32, 23.2, 0., 42.7) B(1.46, 37., 0., 73.) B(1.46, 37., 0., 73.)1.9*(1./((1./U(0.5,0.5))‐1.))**(1./2.03)

B(0.92284,6.8837,0.00063657,43)

B(0.92284,6.8837,0.00063657,43)

B(0.92284,6.8837,0.00063657,43)

GEN_SURG B(1.48, 152, 0., 265) G(1.73, 2.)1.74*(1./((1./U(0.5,0.5))‐1.))**(1./1.96)

1.96*(1./((1./U(0.5,0.5))‐1.))**(1./1.76) P6(1.34, 5.4, 14.9)

3.11*(1./((1./U(0.5,0.5))‐1.))**(1./1.59)

B(0.92284,6.8837,0.00063657,43)

B(0.92284,6.8837,0.00063657,43)

B(0.92284,6.8837,0.00063657,43)

ORTHO B(3.93, 79., 0., 55.2)B(1.6154,4.5134,‐0.034253,9.7619)

B(1.6154,4.5134,‐0.034253,9.7619) B(1.5, 43.2, 0., 94.8) G(1.63, 2.) G(1.63, 2.)

B(0.92284,6.8837,0.00063657,43)

B(0.92284,6.8837,0.00063657,43)

B(0.92284,6.8837,0.00063657,43)

TRAUMA_CRIT_CARE_SURG P6(1.06, 2.81, 9.98) P6(1.14, 6.63, 23.8) P6(1.14, 6.63, 23.8)2.03*(1./((1./U(0.5,0.5))‐1.))**(1./1.71) P6(1.4, 5.26, 13.5)

3.01*(1./((1./U(0.5,0.5))‐1.))**(1./1.35) P6(1., 3.35, 20.3) P6(1., 3.35, 20.3) P6(1., 3.35, 20.3)

Vasc W(0.846, 2.3) P6(1.08, 6.36, 20.) B(1.35, 33.1, 0., 48.)B(0.84565,5.6434,0.0072106,14.688)

3.05*(1./((1./U(0.5,0.5))‐1.))**(1./1.43)

2.49*(1./((1./U(0.5,0.5))‐1.))**(1./1.68) P6(1.01, 4.34, 22.2) P6(1.01, 4.34, 22.2) P6(1.01, 4.34, 22.2)

STROKE P6(1.42, 5.42, 13.5) P6(1.42, 5.42, 13.5)B(1.0794,7.5301,0.042517,22.561) G(1.03, 3.02)

2.87*(1./((1./U(0.5,0.5))‐1.))**(1./2.08) G(1.41, 2.) P6(1.01, 4.34, 22.2) P6(1.01, 4.34, 22.2) P6(1.01, 4.34, 22.2)

CARDIAC_SURG B(0.96663,12.905,0.0083333,39.989)

B(0.96663,12.905,0.0083333,39.989) G(0.8, 4.3) ER(3.51, 2.) ER(3.51, 2.) P6(3.2, 3.54, 2.77)

B(0.92284,6.8837,0.00063657,43)

B(0.92284,6.8837,0.00063657,43)

B(0.92284,6.8837,0.00063657,43)

ONC B(1.02, 21.8, 0., 113) B(1.02, 21.8, 0., 113) B(1.02, 21.8, 0., 113)3.65*(1./((1./U(0.5,0.5))‐1.))**(1./1.61)

2.48*(1./((1./U(0.5,0.5))‐1.))**(1./1.43) P6(1.12, 2.74, 7.14) P6(1.01, 4.34, 22.2) P6(1.01, 4.34, 22.2) P6(1.01, 4.34, 22.2)

CRITICAL_CARE B(0.57171,4.1794,0.015972,53.147)

B(0.57171,4.1794,0.015972,53.147) P6(1.01, 5.68, 19.6)

2.44*(1./((1./U(0.5,0.5))‐1.))**(1./1.86) P6(1.35, 3.3, 8.53)

2.69*(1./((1./U(0.5,0.5))‐1.))**(1./1.41) P6(1., 3.35, 20.3) P6(1., 3.35, 20.3) P6(1., 3.35, 20.3)

CARDIOTHORACIC_SURG B(0.68832,1.5074,0.044977,10.305)

B(0.68832,1.5074,0.044977,10.305)

4.2*(1./((1./U(0.5,0.5))‐1.))**(1./1.42)

B(0.93291,42.406,0.0027778,186.97)

B(0.93291,42.406,0.0027778,186.97)

6.05*(1./((1./U(0.5,0.5))‐1.))**(1./1.78)

B(0.92284,6.8837,0.00063657,43)

B(0.92284,6.8837,0.00063657,43)

B(0.92284,6.8837,0.00063657,43)

• Routing Sequence for PCU Level of AcuitySource: Transfer Center

Data Collection / Data Input

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1 2 3 4 5 6

HOSPITALISTS Unit_W_08 Unit_M_08PCU Unit_M_10PCUUnit_S_08PCU_S_08SW

Unit_M_07PCU2 Unit_W_12

PRIM_CARE Unit_M_08PCU Unit_W_08 Unit_M_10PCUUnit_S_08PCU_S_08SW Unit_M_07PCU Unit_W_12

CARDIOUnit_S_07PCU_S_07SW

Unit_S_08PCU_S_08SW

Unit_S_09PCU_S_09SW Unit_M_08PCU Unit_W_08 Unit_M_10PCU

GEN_SURG Unit_M_10PCU Unit_M_09PCU Unit_M_07PCU Unit_M_08PCU Unit_E_07Unit_M_07PCU2

ORTHO Unit_M_09PCU Unit_M_10PCU Unit_W_12 Unit_M_08PCU Unit_E_07 Unit_W_08TRAUMA_CRIT_CARE_SURG Unit_M_09PCU Unit_M_10PCU Unit_W_12 Unit_M_08PCU Unit_M_07PCU Unit_E_07

Vasc Unit_M_07PCU Unit_E_07 Unit_M_07PCU2Unit_S_07PCU_S_07SW Unit_M_10PCU Unit_W_08

STROKE Unit_W_12 Unit_M_09PCU Unit_W_08 Unit_M_08PCU Unit_E_07Unit_S_07PCU_S_07SW

CARDIAC_SURGUnit_S_09PCU_S_09SW Unit_S_09TSU Unit_M_10PCU

Unit_S_07PCU_S_07SW

Unit_S_08PCU_S_08SW Unit_E_07

ONC Unit_W_08 Unit_M_08PCU Unit_M_10PCU Unit_E_07Unit_S_07PCU_S_07SW

Unit_S_09PCU_S_09SW

CRITICAL_CARE Unit_M_08PCU Unit_W_08 Unit_M_10PCUUnit_S_08PCU_S_08SW

Unit_S_07PCU_S_07SW Unit_E_07

CARDIOTHORACIC_SURG Unit_S_09TSU

Unit_S_09PCU_S_09SW Unit_M_10PCU

Unit_S_07PCU_S_07SW

Unit_S_08PCU_S_08SW Unit_E_07

• Transfers Between Units (2 of 8 Route Matrices)Up (in Acuity), Down (in Acuity), Lateral

Order of Routing 1 2UDLO PERCENTS UDLO PERCENTS

SERVICE U D L O U D L OHOSPITALISTS 0.11684 0.203326 0.059044 0.62079 0.067051 0.121551 0.021144 0.790253PRIM CARE 0.118168 0.191039 0.069916 0.620876 0.076932 0.136582 0.027964 0.758521CARDIO 0.06833 0.206774 0.055556 0.66934 0.045484 0.132928 0.014094 0.807495GEN SURG 0.071948 0.077398 0.041061 0.809593 0.104982 0.133452 0.046708 0.714858ORTHO 0.020276 0.022247 0.015207 0.94227 0.051306 0.065299 0.04944 0.833955TRAUMA CRIT CARE SURG 0.108108 0.265766 0.085586 0.540541 0.08518 0.230921 0.041851 0.642048Vasc 0.119806 0.08041 0.060443 0.739342 0.119895 0.130435 0.071146 0.678524STROKE 0.041916 0.203593 0.047904 0.706587 0.036606 0.182196 0.022463 0.758735CARDIAC SURG 0.413302 0.251781 0.228029 0.106888 0.199806 0.56935 0.084384 0.14646ONC 0.058104 0.042813 0.107034 0.792049 0.080906 0.116505 0.11165 0.690939CRITICAL CARE 0.11284 0.093385 0.101167 0.692607 0.097691 0.186501 0.031972 0.683837CARDIOTHORACIC 0.255319 0.092199 0.085106 0.567376 0.114068 0.087452 0.057034 0.741445

Data Collection / Data Input(Same Acuity) or Out (Discharge)

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How can we be sure this model is Accurate (Validation &

Verification)

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VALIDATION (MODEL VS. EMPIRICAL) AVERAGE LENGTH OF STAY BY SERVICE LINE

SERVICE LOS DAYS MODELLOS DAYS EMPIRICAL

PERCENT CHANGE

HOSPITALISTS 5.56 5.73 -3.2%PRIM CARE 5.38 5.42 -0.7%CARDIO 3.65 3.65 0.1%GEN SURG 4.82 4.98 -3.4%ORTHO 2.96 3.11 -5.2%TRAUMA CRIT CARE SURG 7.66 7.75 -1.2%VASC 4.74 5.09 -7.3%STROKE 4.90 5.16 -5.4%CARDIAC SURG 8.92 8.69 2.6%ONC 7.06 7.32 -3.7%CRITICAL CARE 7.04 7.40 -5.1%CARDIOTHORACIC SURG 9.90 10.63 -7.3%

AVG OF ALL SERVICES 5.20 5.30 -2.0%

Comparison of Means: Empirical vs. Model-Generated Data

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AVG DAILY CENSUS

Comparison of Means: Empirical vs. Model-Generated Data

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30.00 Validation of Average Unit Census (Empirical Range = +/- 1.5)

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