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Improvement of bed occupancy in nursing wards; a redesign of the planning an control of the UMCG Beatrix Kinderziekenhuis

(2015) Veldhuis, Thijs

This thesis provides an analysis of the current planning and control system of nursing wards at the UMCG Beatrix Children’s Hospital (BKZ). Building on its outcomes, suggestions for a redesign are proposed to optimize the bed occupancy while guaranteeing patients patient accessibility to nursing wards in the BKZ.

At this moment, the BKZ experiences a low bed occupancy of 71% and a low patient accessibility expressed by 7% misplacements. This is undesired from both cost and service perspective. Patient accessibility is measured by fraction of refused admissions and fraction of misplacements. A refused admission is the consequence of an arriving patient when all nursing wards are fully occupied. A misplacement is the result of an admission to an undesired ward when the preference nursing ward is fully occupied. The management of the BKZ accepts 5% refused admissions at most, which is currently more than achieved. The bed occupancy should be optimized while guaranteeing these maximum allowed refused admission and keeping the misplacements in an acceptable range. This can be achieved by a redesigned planning and control system. Hence, the research objective for this thesis is:

To analyze and redesign the planning and control system for the nursing wards of the BKZ to achieve a higher bed occupancy within at most 5% refused admissions while not increasing the current fraction of misplacements.

The thesis provides a research plan consisting of four steps to attain this research objective.
First, a literature study is conducted to find design parameters for nursing wards planning and control systems. The following were found relevant and play a central role in this research:
Temporary bed capacity change
Staff-shift scheduling
Admission control
Discharge planning
Elective admission rescheduling
Second, the current design of the planning and control system is described in terms of the five design parameters.

Third, the performance of this design is analyzed. This is first done by performing a rough-cut capacity check, exploring patterns in bed occupancy, exploring bed occupancy per patient group and exploring the realization of the planning. Next, the observed performance is linked to the five design parameters to identify possible causes of low performance.

Fourth, the planning and control system is redesigned which suggests solutions for the causes found in the previous part. This is first done by developing proposals with alternative settings for the admission control and discharge planning to reduce variability in bed occupancy. Then the outcomes are estimated by rescheduling the patients according to the developed alternatives. Finally, within this final redesign proposal a suggestion is elaborated when the variability is reduced to achieve a higher bed occupancy within at most 5% refused admissions while not increasing the current fraction of misplacements.

The research plan led to an analysis and a redesign of the current planning and control system of nursing wards at the BKZ.
The analysis showed that variability in bed occupancy resulted in low patient accessibility, since patients are misplaced or refused during peak moments. This variability is mostly caused by elective (planned) patients in combination with the closing of a nursing ward in the weekend.
The main findings of the redesign are that variability can be reduced by forecasting the length of stay and collaboration between planners of each specialism and the admission office. After this, a higher bed occupancy can be achieved by admitting more patients or by closing beds, i.e. reducing nursing staff.

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