Joint evaluation of surgical patient scheduling and admission policies with bed management

In many hospitals, the bed capacity available for inpatients is limited and the lack of bed management for scheduling and admitting patients can lead to bed shortage and disrupt the admission of inpatients. If a bed shortage occurs, elective inpatients need to be rescheduled for a later admission, and emergency inpatients are diverged to other hospitals. In this paper, we devise a set of policies for the scheduling of elective patients and the admission of emergency patients that include bed management through thresholds for the occupancy of hospital beds and patient-to-bed assignment rules. We consider four key performance indicators to evaluate the policies: the percentage of refused emergencies, the percentage of overdue electives, the percentage of timed-out emergencies, and the percentage of elective rescheduling. The patient length-of-stay forecast, as well as the policy for managing the operating room capacity (master surgery schedule or open block), impacts the scheduling and admission policies. We run a discrete event simulation across several settings combining patient scheduling and admission policies, length-of-stay forecasts, operating room management rules, and emergency patient flow levels. The simulation experiments enable to identify the best policies for the scheduling and the admission of patients, as well as evaluate the impact of the other factors on key performance indicators. The results show that policies incorporating bed occupancy thresholds are highly effective in controlling key performance indicators. In particular, applying a bed occupancy limit to elective patient scheduling yields the best trade-off between emergency admissions and timely access for elective patients, provided the limit is appropriately set according to the expected emergency flow.