Design and Analysis of Hospital Admission Control for Operational Effectiveness
Article first published online: 17 FEB 2011
© 2011 Production and Operations Management Society
Production and Operations Management
Volume 20, Issue 3, pages 359–374, May/June 2011
How to Cite
Helm, J. E., AhmadBeygi, S. and Van Oyen, M. P. (2011), Design and Analysis of Hospital Admission Control for Operational Effectiveness. Production and Operations Management, 20: 359–374. doi: 10.1111/j.1937-5956.2011.01231.x
- Issue published online: 13 MAY 2011
- Article first published online: 17 FEB 2011
- History: Received: December 2008; Accepted: September 2010, after 2 revisions.
- health care operations;
- patient flow modeling;
- Markov decision processes;
- admission control
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 mitigate these problems. Currently there are two major gateways for admission to a hospital: the ED and scheduled elective admission. Unfortunately, in highly utilized 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 threshold 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.