Bed Stock Research Articles

Understanding Patient Flow from the Perspectives of Patient Movement Experts

Background: Poor patient flow or patient movement through a healthcare organisation can lead to adverse outcomes for patients and organisational inefficiency. Many hospitals have addressed suboptimal patient flow by increasing resources, such as bed stock and staffing; however, this is an unsustainable approach. In determining the nature of poor patient flow issues, it is important to collect data from healthcare professionals who manage patient flow daily. Doing so provides insights into the current state of patient flow management in its entirety, whilst also helping with the development of sustainable solutions. Methods: Thirteen semi-structured interviews were conducted with healthcare professionals who were directly involved with patient flow at a referring hospital in Tasmania, Australia. Results: Using a thematic analysis method, four major themes were developed. The first major theme was: ‘managing patient flow’ which centered around known and unknown demands on bed availability. The second theme, ‘communication for decisions’, highlighted the essential role of communication in maintaining patient flow. The third theme, ‘tools as enablers and barriers, relates to the number of software programs which can both help and hinder patient flow. The final theme of ‘increasing complexity’ is related to an apparent trend towards greater numbers of patients requiring care of an increasingly specialised nature. Conclusions: The findings of this study provide great insights into patient flow issues, with potential solutions identified to address them.

Территориальные особенности оказания экстренной хирургической помощи сельскому населению (на примере Республики Северная Осетия-Алания).

The need to modernize healthcare dictates the study of healthcare organization at all levels. Special attention is paid to the territorial accessibility of medical care, including to the rural population, which differs in many specific features. The purpose of the study: to study the territorial features of providing emergency surgical care to the rural population, taking into account the number, density of population settlement, road infrastructure, and transport security in the Republic of North Ossetia-Alania. Research methods. Analytical and statistical research methods were used. The performance indicators of surgical departments of rural district hospitals for 2019–2022 have been studied. The analysis of the obtained data was carried out by the method of their structural description according to the selected main characteristics affecting territorial accessibility. Results. The Republic of Ossetia-Alania is characterized by high density and compactness of population settlement in rural areas. The creation of a modern transport infrastructure ensures the territorial accessibility of medical care. The republic has a fairly high level of provision with surgeons (2,53 per 10 thousand population) and a surgical bed fund (4,7 per 10 thousand population). However, there is a need to increase the efficiency of using the bed stock of rural surgical hospitals. The organization of surgical care in the republic in 2020–2021 was extremely negatively affected by the pandemic of coronavirus infection COVID‑19. The reduction of surgical and anesthesiological teams, beds and the volume of planned care due to the opening of additional infectious diseases hospitals has reduced the availability and quality of emergency surgical care. In rural district surgical departments, the bed function decreased from 283 days in 2019 to 243 days in 2020, and surgical activity up to 38,8%. In 2020–2021, planned medical care in the «surgery» profile has significantly decreased. The share of emergency hospitalizations increased to 79,7%. Negative trends in the growth of emergency hospitalization for surgical beds led to an increase in the hospital mortality rate compared to 2019 from 0,6% to 3,1% in 2021. The postoperative mortality rate has increased by more than 5 times. Our data correlate with similar trends of 33% increase in hospital mortality in the Russian Federation during the pandemic. Due to the creation of modern road transport infrastructure in the republic, high availability of surgical beds and surgeons, there is a potential to improve the quality indicators of rural surgical hospitals by improving the material and technical equipment and qualifications of surgical personnel.

A data-driven decision support tool to improve hospital bed cleaning logistics using discrete event simulation considering operators’ behaviour

Beds are a critical resource for hospitals, requiring effective management to ensure the quality of care for patients. Beds operate in a closed-loop circuit and must be thoroughly cleaned between patients’ arrivals to prevent infections. Hospitals must implement efficient logistics systems to collect, transport, store, and clean unclean beds from discharged patients. These systems must be robust and efficient to meet the varying bed supply needs, given the available resources such as beds, staff and machines. This study aims to develop a decision support tool to optimise bed cleaning logistics and ensure the availability of sterile beds for incoming patients at all times. The study is based on the bed flow and cleaning organisation of a Danish public hospital. A discrete event simulation model (DES) of the back-end bed flow has been developed. The paper also presents a tension level indicator to reflect the behaviour of cleaning staff when facing variations in demand and bed stock. Using the organisational set-up (staff schedules, policies, and bed fleet size), the DES model: (1) evaluates the ability to provide sterile beds in a reasonable time, (2) measures the stress on cleaning staff, and (3) visualises resource usage. This study illustrates how to incorporate the staff’s perceived workload and resulting behaviour into a DES model to capture the behavioural aspect of staff’s decision-making.

Some of the Dilemmas About Creating Arteriovenous Fistulas for Hemodialysis

Abstract The native arteriovenous fistula for haemodialysis has been described as the Achilles heel but also the Cinderella of haemodialysis. Arteriovenous fistula has been the vascular access of choice for haemodialysis, because of lower cost, morbidity and mortality. The significance of a functioning vascular access is that it takes on a major role in determining a positive outcome. Yet, they are a cause of great stress, both for patients and healthcare professionals. About 80% of patients begin dialysis with central venous catheters, 20-70% of fistulas do not reach maturity, and a fifth, of all fistulas, thrombosed before use. A quarter die from poor vascular access. Insufficient number of vascular surgeons and inadequate training to create vascular access often lead to "congestion" of the bed stock in nephrology. Surgeons and radiologists perform all procedures related to vascular approaches, but the dominant role of nephrologists is in the organization of planning and realization of creating a vascular access. Initiation of dialysis in the elderly and diabetics, as a risk population of patients for arteriovenous fistula, is associated with many problems, among which the creation, functioning and maturation of the vascular access dominate. Hyperdynamic conditions, due to arteriovenous communication in patients with arteriovenous fistula, are cited as a possible mechanism for increasing morbidity. However, there is still no agreement within the nephrology community regarding the height of the hemodynamic load and the indication for closing the vascular access. There are many dilemmas associated with creating, care and using an arteriovenous fistulas, and that could be the reason and justification to form a team for vascular access, which would, in addition to nephrologists, include vascular surgeons, interventional radiologists and nurses.

The ways to resolve problems of forming reserve bed stock on purpose to decrease population mortality

The article presents analysis of reduction of bed stock, including infectious hospitals, resulted from modernization, intensification and improvement efficiency of processes in health care of Russia. The pandemic of new coronavirus infectious COVID-19 led to increase of mortality not only because of this infection and its complications, but also to large extent from a number of other non-communicable diseases because of forced changes in system of medical care. The article analyzes mortality from the coronavirus infection COVID-19 and a number of non-communicable diseases. The ways of forming reserve bed stock to reduce population mortality are proposed.

The experience of Japan: the application of the intersectoral balance methodology to control health care costs as a factor of mobilization readiness of health care to COVID-19 pandemic

One of possible reasons for success of Japan in confronting the COVID-19 pandemic (low mortality rates, refusal of hard lock-downs and relatively low fall in economy) is seen in record high (3-4 times higher than in most other developed countries) provision of hospital beds. Its financing was supported during first 2 decades of the XXI century by the policy of relative to GDP advanced growth of public health public expenditures based on assessment of multiplier impact of these expenditures on demand, production and employment in other sectors of the economy using the intersectoral balance method based on "input-output" tables.Purpose of the study is to analyze Japan's economic policy in managing budgetary health care costs.The comprehensive statistical, comparative and retrospective analysis of available data was applied.The study results permit to suggest that high provision of the Japan population with hospital care resources and low mortality rates in 2022 prior to development of vaccines and effective treatment schemes for COVID-19 can be explained, among other things, by long-term policy of managing health care costs using assessment of their effect on production growth, demand and employment in other economy sectors using intersectoral balance method based on regular compilation of "input-output" tables.The data obtained permits to characterize as promising approach of the Japanese government to management of health care costs using assessment of their effect on production growth, demand and employment in other sectors of the economy using intersectoral balance method based on the regular compilation of "input-output" tables. This approach permitted to increase up to 1.5 times health care costs during 2005-2018 in situation of chronic stagnation of the national economy and thus to avoid world-wide trend towards reduction of hospital bed stock and after the start of pandemic severe shortage of hospital beds. The positive experience of Japan is confirmed by encouraging results of 2 pilot projects in the EU countries on applying the intersectoral balance method to assess the multiplier effect of health care costs in 2017-2018. It is considered that using the experience of Japan in managing budgetary health care expenditures through intersectoral balance method is challenging.

Current trends in the organization of rehabilitation care for patients after total hip replacement

The pandemic caused by the novel coronavirus infection COVID-19 dramatically increased the burden on healthcare, which led to the repurposing and limitation of the bed stock in rehabilitation centers. That served as the basis for the search for new approaches to the treatment and routing of patients, including using remote-controlled rehabilitation. The aim of the study was to evaluate the effectiveness and safety of motor rehabilitation in patients after hip replacement with the use of telerehabilitation technologies. Materials and methods: In a retrospective study, 32 patients aged 40 to 75 years who underwent rehabilitation after hip replacement using telemedicine technologies were examined. After discharge from the surgical hospital, all patients were offered a link to receive a program of motor rehabilitation, including exercise therapy complexes and a video clip on the technique of performing these exercises. In addition, online classes with a physical therapy instructor were conducted for patients with technical capabilities. The rehabilitation program started from the first day after surgery and lasted 90 days. To assess the effectiveness of rehabilitation, all patients underwent testing, including questionnaires and mobility tests, which were conducted on the second day and 3 months after surgery. Results: Rehabilitation with the use of telemedicine for patients after hip replacement demonstrates a positive clinical effect, assessed by mobility tests (TUG and the 6‑minute walk test), the EQ-5D quality of life scale, the SF-36 questionnaire and State-Trait Anxiety Inventory test. Conclusion: The criteria for patient inclusion developed by us, special physical therapy programs, and a routing model with remote rehabilitation treatment can become an effective alternative to the full-time rehabilitation, in case of paramedical difficulties for its implementation.

(I can't get no) satisfaction: A comparative study of healthcare recommodification in Europe, 2010-18

European health reforms during the last decades have strengthened patient rights and introduced choice, competition and financial incentives in a sector that has typically been state-directed and centrally controlled. The marketisation of health care has also drawn out profit and introduced private provision. The main argument behind this trend is that market competition will improve service quality and deliver health services more efficiently. Such reforms often fall under the umbrella of New Public Management (NPM), and there is a lack of empirical research on their effects. The purpose of this paper is to investigate the association between healthcare marketisation and health system outcomes across European nations. In order to measure a country's degree of healthcare marketisation we employed indicators of healthcare decommodification. The concept refers to the extent to which an individual's access to healthcare is dependent upon their market position and the extent to which a country's provision of health is independent from the market. These indicators are three measures that assess the financing, provision and coverage of the private sector, and thus reflects the varied role of the market in a health care system: private health care expenditure as amount of GDP, private hospital beds as amount of total hospital bed stock, and public healthcare coverage. As indicator of health system outcome, we employed a measure that has not previously been investigated in the context of healthcare marketisation: satisfaction with health care system. We used multilevel analyses on five waves (2009–2017) of the biannual European Social Survey (ESS), with our final models including more than 120,000 individuals from 21 countries. Our methodological approach allowed us to study both cross-sectional and longitudinal relationships. The strongest substantial associations were between coverage and satisfaction, with high public healthcare coverage being associated with higher satisfaction.

Особенности состояния сети и обеспеченности коечным фондом медицинских организаций в России

The implementation of the healthcare development strategy, effective management of the healthcare system is impossible without monitoring and comprehensive comparative analysis at various levels of the state and development of the network, resources and activities of medical organizations, individual services and the healthcare system as a whole. P u r p o s e of the study is scientific assessment of the state of the network of medical organizations providing medical care in outpatient and inpatient settings, as well as analysis of the provision of beds for the population of the Russian Federation in 2012–2019. M a t e r i a l s a n d m e t h o d s . Within the framework of the conducted research, official statistics data were analyzed, modern trends and trends in the provision of beds and the state of the network of medical organizations in Russia at the regional level were determined. Statistical data processing was carried out using SPSS, Excel‑2007 packages. Such methods as analytical, statistical methods, study and generalization of experience, comparative analysis were used. R e s u l t s . The analysis has shown that the unevenness and the level of high differentiation of indicators of provision of beds by subjects of the Russian Federation remains. Thus, over the period 2012–2019, the provision of specialized beds for all the main profiles of beds is decreasing, the largest reduction affected socially significant beds – dermatovenerological – by 1,5 times, as well as therapeutic – by 32,5%, gastroenterological – by 28,2%, pediatric – by 24,4%, and infectious – by 20,3%. F i n d i n g s . The results of this study confirm the reduction in the number of beds of the main profiles, as well as the conversion of part of the bed stock, especially in the context of a pandemic of a new coronavirus infection, which showed the need for structural and functional transformations of health resources in general and the bed stock in particular.

Epidemiological trends in tuberculosis in Ukraine at the beginning of the COVID­-19 pandemic

Objective — to examine the tendencies of the epidemiological situation on tuberculosis in Ukraine at the beginning of the COVID-19 pandemic in 2020. 
 Materials and methods. The analysis of the data of official statistics in 2015—2020, a survey of 157 medical experts and a telephone questionnaire survey of 69 residents of the Volyn region.
 Results and discussion. It was established that the disease of COVID-19 has found its imprint on the epidemiological situation of tuberculosis and on the functioning of the TB care service. In 2020, the rate of decline in the incidence of pulmonary and extrapulmonary tuberculosis was significantly more intensive than in previous years. However, the incidence of tuberculosis among contacts with bacterial excretion in tuberculosis foci increased 1.85 times in each year. The frequency of tuberculosis recurrences is steadily decreasing.The prevalence and mortality from all forms of active tuberculosis among the entire population of Ukraine has a tendency similar to a decrease in morbidity.The effectiveness of treatment of patients of all categories is proportional to the severity of the tuberculosis process, but still insufficient. Mortality in TB care institutions increased in the previous year against the decrease of this indicator in previous years. Against the background of the inaccessibility of the population to TB care, day hospitals are underused, and the sanatorium network needs to be reorganized. The surgical method of treatment of patients is extremely insufficiently realized.
 Conclusions. The dispensary contingent of TB care institutions is decreasing every year. There is a reduction in the infrastructure of the TB care service, and in each year, the largest reduction was in the bed stock of TB care institutions and sanatoriums, as well as a decrease in the number of TB doctors.

Tasks, shortcomings and reservations in the process of reforming the specialized dermatovenereological sector of health care

Objective — to draw the attention of the Ukrainian health care management, the National Health Care Service (NHCS) and dermatovenereologists to urgent issues of reforming the industry, identifying shortcomings in the reform and presenting the views of experienced professionals on correcting organizational measures.Official statistics was used based on the materials of leading specialists of Kharkiv Research Institute of Dermatology and Venereology, scientific and practical institutions of Ukraine, the forecast of «GlobalData» analytical and statistical company on the trend of syphilis in the world, the results of discussion of current reform issues with leading specialists in dermatovenereology.The interpretation of the modern epidemiological panorama of skin and venereological pathology, the current state of organizational and material support of dermato-venereology institutions are presented. Some specific shortcomings and miscalculations in the process of reforming are revealed from the point of view of experienced specialists in the field, the authors’ vision of ways to improve the organization and activity of the dermatovenereological service of the country is presented.The need for correction in the process of reforming the specialized dermatovenereological service by resolving the urgent issue of organization in the areas of round-the-clock bed stock within reasonably adjusted limits and their financial and material support is substantiated. Calculations of the needs of round-the-clock inpatient beds in the regions should be carried out in the NHCS with the participation of the leadership of the Ukrainian Association of Dermatovenereologists and Cosmetologists (UADVC). The reforming of the dermatovenereology service should become a truly effective compo­nent of the generally progressive system of health care reform, taking into account the international medical and statistical forecasts.

Оцінка якості надання медичної допомоги за даними щорічних звітів (на прикладі уролоґічного відділення Львівської комунальної міської клінічної лікарні швидкої медичної допомоги)

Aim. The medical care quality remains one of the most pressing issues of the health care system, especially at the stage of reforming of the medical sector. Medical-statistical information comprising reporting forms is the basis for analyzing the status of medical care quality and incorporating management decisions to improve it. Material and Methods. The study was performed by the means of analysis of the annual reports of the Urology Department of Municipal Non-profit Enterprise "Lviv Clinical Emergency Hospital" over a ten-year period: from 2010 to 2019. Statistical analysis included the analysis of average and relative values, as well as the calculation of indicators of the dynamic range: growth rate and absolute increase. Results and Discussion. Analysis of the use of bed stock of the Urology Department of MNELCEH during 2010-2019 showed that the average quantity of inpatient days is 251.12-340.18 days per year. Inpatient turnover was in the range of 30.28-36.55 patients per year. The indicator of surgical activity increased by 5.4 percentage points (from 33.0% in 2010 to 38.4% in 2019). There was also a positive tendency of decrease of the duration of post-surgery stay of patients at the inpatient department of the Urology Department (from 9.25 in 2010 to 8.55 in 2019). During the study period of 2010-2019, the ratio of post-surgical complications remained relatively stable and did not exceed 5.1% (the indicator is in the range of 4.38% -5.09%). The analysis of the total mortality among all treated patients was in the range of 0.06%-0.65%. Conclusion. The indicators analyzed in the annual reports make it possible to identify the main problematic issues in the work of the department. In order to provide professional specialized care, quality and rational use of property and human resources, algorithms should be developed to increase treatment of patients with malignant tumors and urolithiasis at the department, as in recent years we could observe an outflow of patients with these diagnoses to other healthcare establishments. There is a need for individual analysis of the causes of post-surgical complications and mortality. These issues can be resolved by introducing clinical audit into the work of the department

The approaches to planning of medical infrastructure and bed stock in medical organizations in conditions of development and spread of coronavirus infection COVID-19

The article presents key approaches to methods of assessing and prognosticating the need both for bed stock, considering level of morbidity and epidemiological process in conditions of development and prevalence of coronavirus COVID-19 infection, and as well the regional network of medical organizations of public and municipal health care that should be reoriented to medical care support during pandemic according to 14 evaluation criteria.

Current state of the labor system in healthcare

The publication presents an analysis of the modern regulatory framework for labor, shows controversial positions on each component of the labor rationing system in healthcare. The amount of normative time spent on visits to outpatient doctors, established by orders of the Ministry of Health of Russia, in the main medical specialties: doctors-therapists district, pediatricians district and general practitioners (family doctors), does not coincide with the data of the territorial program. Approved more than 20 years ago and currently in force standards for laboratory and instrumental examinations do not correspond to the modern equipment of medical organizations. The numbers of health workers providing primary health care to the population, established by the orders on Procedures and Regulations, for the majority of medical personnel have different meanings in the simultaneously valid regulatory documents for the provision of medical care to both adults and children. The planned and normative volume of work on outpatient care has not been reported since 2013, either in visits or in appeals about diseases. The planned and normative indicators for the amount of hospital care are characterized by sharp annual changes that are not justified either by the morbidity of the population or by the technologies of the medical process, do not correspond to the actual development of the bed stock and are not reflected by healthcare practice. Based on the analysis of time standards, norms of number and planned volume of work, the authors make a reasonable conclusion about serious problems in the system of labor rationing in healthcare. The authors identified the necessary measures for its restoration and revision of the entire labor regulatory framework, which are the need to include labor rationing issues in the program of diploma and postgraduate training of doctors in a healthcare organization; advanced training of developers of staff standards and specialists approving these documents; mandatory expert assessment of documents on labor standards prior to their approval by qualified specialists on labor standardization in health care.

Socio-economic disadvantage and resource distribution for mental health care: a model proposal and example application for Victoria, Australia.

A spreadsheet-based model for supporting equitable mental health resource distribution in Australia was developed, based on the Australian Health Survey (AHS) psychological distress findings associated with area socio-economic disadvantage (SED). An illustrative application is presented. Stratum-specific psychological-distress rates for area SED quintiles are applied to local government areas, catchment areas and local health networks (LHNs). A case study applies the model to Victoria, including examining recommendations in the Royal Commission into Victoria's Mental Health Services (RCVMHS) 2019 interim report for increases to bed stock in two LHNs. Need-adjusted demand estimates considered as a ratio of raw population proportions for catchments range between 0.6 to 1.4 in Victoria. Applying the formula to the Royal Commission recommendations suggests the proposed distribution of beds is a reasonable correction for these two LHNs and indicates next expansion priorities for more equitable distribution to other LHNs. The spreadsheet, adaptable for other states and territories, could complement National Mental Health Services Planning Framework outputs and assist in evaluation, for instance, determining potential supply shortages in the tele-mental-health response to COVID-19. We outline research directions including consideration of the moral bases of value judgements and identification of other variables including their use in parameterisation and calibration.

Availability and need for population of the federal districts in hospital beds

Providing the population with the necessary bed stock is an important task of public health. In order to compare the level of security and the population's need for hospital beds in the territory of the Federal districts of Russia, the study used the following methods: analytical, logical and descriptive statistics. Data on the population and bed Fund were taken from the official reports of Rosstat and the Ministry of health of Russia for 2016-2018. The population's need for hospital beds was calculated as the ratio of the product of the number of bed days per 1000 inhabitants and the population to the average annual bed occupancy multiplied by 1000. In the course of the study, the dynamics of the reduction of the bed stock in various profiles was identified and the population's need for hospital beds was determined, taking into account various variants of the population forecast. It was found that the optimization of hospital beds, in addition to economic interests, should be considered opportunities for providing outpatient and inpatient care, improve efficiency and quality of hospital care, as well as the necessity of forming a reserve of hospital beds in case of mass sanitary losses or increase the level of hospitalization of citizens in a short period of time.

The modernization of personnel support of the Moscow psychiatric service in 2010-2017

The modernization of the Moscow psychiatric service consisted in reduction of hospital service and development of out-patient service. The first stage of modernization (2010-2016) the psycho-neurological dispensaries were joined to psychiatric hospitals and bed stock was reduced or restructured for different function. The second stage of modernization (2017) consisted in such modernization of hospital network as further reducing of bed stock and unification of psychiatric hospitals. The third stage (2017-2020) presupposes development of out-patient care. The purpose of study was establishing provision of personnel resources of Moscow psychiatric institutions and analysis of dynamics of personnel resources during modernization period. The study is a continuous retrospective analysis of personnel of Moscow psychiatric service in 2008-2017. In this period number of occupied job positions of district psychiatrists decreased from 0.28 to 0.25 per 10 000 of population. In the Russian Federation provision with district psychiatrists made up to 0.23 per 10 000 of population in 2017. In 2027, the provision with psychiatrists of population made up to 1.15 in Moscow and 0.83 in the Russian Federation per 10 000 of population. In 2015-2017, in Moscow, quantity and staffing of out-patient job positions in Moscow psychiatric institutions increased. In 2017, the staffing of job positions in out-patient institutions made up to 63.5%-77%. In 2008-2017, in Moscow, total number of visits per district psychiatrist increased up to 36.5% for adults and up to 140.5% for adolescents and up to 5.3% for children. The percentage of psychiatrists with qualification category decreased from 2007 to 2017 and in 2017 made up to 40.4% in Moscow and up to 50.9% in the Russian Federation.

Hydrological pulses and burning of dissolved organic carbon by stream respiration

AbstractStream metabolism plays a significant role in the global carbon cycle. Storm events can lower stream metabolic activities by removing standing biomass and river bed stock of organic matter. However, hydrological events could also stimulate stream ecosystem respiration (ER) by providing dissolved organic carbon (DOC) derived from soils. Here, I show how hydrological connectivity between land and water affects fluxes of DOC and daily whole stream bacterial respiration over an annual cycle in streams rich in DOC in north‐west Europe. The novelty of the approach resides in combining continuous whole stream metabolism with hydrological flow paths and water chemistry to quantify the in situ fate of DOC at ecosystem scale, with an estimation of all major stream carbon fluxes (land‐derived CO2, in‐stream biotic CO2, HCO3, and DOC) at catchment scale. An average 23% ± 11% of the annual DOC inputs from the land was respired away by benthic microbial metabolism within about an hour of transit time in small watersheds (about 1 km2). Stream ER was highly related to discharge and was stimulated for as long as the hydrological connectivity between land and water remained, as indicated by soil moisture continuous monitoring. In‐stream heterotrophic respiration represented 16% ± 7% of the annual total carbon fluxes (also including HCO3, land‐derived CO2, and DOC) at the catchment outlet under stable flows. This study suggests that DOC supply (soil carbon loss) will increase with rainfall, stimulating aquatic respiration, and CO2 emissions in streams.

О результатах ранней диагностики и лечения больных локализованным раком предстательной железы в крупном промышленном регионе

The main indicators of organization of urological care in Sverdlovsk region were analyzed. The structure of urological and oncourological morbidity in dynamic from 2000 to 2018 was presented. The data of the personnel structure and bed stock of urological service was shown. The effective methods of men treatment with prostate cancer in the year of 45-80 by the modern methods of SOKB №1: brachytherapy, robot-assisted operations, ultrasound ablation HiFU, radical prostatectomy, laser ablation, hormonotherapy - allow us to prove for the soon improvement and use in regions of Sverdlovsk region (Governor’s program “Urological men’s health» in Sverdlovsk region)

A modelling tool for capacity planning in acute and community stroke services.

BackgroundMathematical capacity planning methods that can take account of variations in patient complexity, admission rates and delayed discharges have long been available, but their implementation in complex pathways such as stroke care remains limited. Instead simple average based estimates are commonplace. These methods often substantially underestimate capacity requirements.We analyse the capacity requirements for acute and community stroke services in a pathway with over 630 admissions per year. We sought to identify current capacity bottlenecks affecting patient flow, future capacity requirements in the presence of increased admissions, the impact of co-location and pooling of the acute and rehabilitation units and the impact of patient subgroups on capacity requirements. We contrast these results to the often used method of planning by average occupancy, often with arbitrary uplifts to cater for variability.MethodsWe developed a discrete-event simulation model using aggregate parameter values derived from routine administrative data on over 2000 anonymised admission and discharge timestamps. The model mimicked the flow of stroke, high risk TIA and complex neurological patients from admission to an acute ward through to community rehab and early supported discharge, and predicted the probability of admission delays.ResultsAn increase from 10 to 14 acute beds reduces the number of patients experiencing a delay to the acute stroke unit from 1 in every 7 to 1 in 50. Co-location of the acute and rehabilitation units and pooling eight beds out of a total bed stock of 26 reduce the number of delayed acute admissions to 1 in every 29 and the number of delayed rehabilitation admissions to 1 in every 20. Planning by average occupancy would resulted in delays for one in every five patients in the acute stroke unit.ConclusionsPlanning by average occupancy fails to provide appropriate reserve capacity to manage the variations seen in stroke pathways to desired service levels. An appropriate uplift from the average cannot be based simply on occupancy figures. Our method draws on long available, intuitive, but underused mathematical techniques for capacity planning. Implementation via simulation at our study hospital provided valuable decision support for planners to assess future bed numbers and organisation of the acute and rehabilitation services.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1789-4) contains supplementary material, which is available to authorized users.