Tackling the bed blocking problem at the Medical Spectrum of Twente

On account of a growing demand for better planning, usage and management of health services the Medical Spectrum of Twente (MST) in Enschede, The Netherlands, attempts to optimize the transmural care chain of the MST and the three aftercare institutions in the catchment area of the MST. In 2011 at the MST a total of 5474 patients were notified to be eligible for aftercare. 1541 of these patients caused a total of 7810 bed blocking days. A patient is a bed blocker from the first day after the patient is medically ready up to and including the day of discharge from the hospital. During this research only patients who are eligible for admission to a nursing home, except readmission, have been studied. This group consists of 1040 patients and accounted for a total of 5266 bed blocking days in 2011. The aim of this study is to determine the influence of five possible interventions on the number of bed blocking days at the MST, the occupation rate at the aftercare wards and three other indicators, with the use of a simulation model. Contrary to the actual situation, in the simulation model the only two causes for bed blocking days can be a shortage of either beds or physicians to perform the admission interview. All five interventions have been studied with n = 101 years and a confidence interval of 95%. The results show that the major problem in the transmural care chain is a shortage of physicians to perform the admission interviews at the BR/SOM ICD and the BR ward. This problem is tackled in two interventions: by increasing the maximum number of admission interviews per day at the BR/SOM ICDs and the BR wards, and, when there is an empty bed at the aftercare institution, give priority to a patient at the MST instead of a patient at the BR/SOM ICD in order to decrease the number of transfers and thereby the number of admission interviews. The advice to the MST and the three aftercare institutions in the catchment area of the MST is to tackle the shortage of physicians in both possible ways and either increase the number of PG beds at the ICD from six to seven or decrease the PG length of stay at the ICD from 31 to 27 days. When only the physician problem is tackled, this causes a decrease in the number of bed blocking days caused by a shortage of either beds of physicians of 70%. However, in combination with an increased number of beds or decreased length of stay of PG patients, the decrease respectively is 88% and 87%. Because of an increasing number of patients due to the aging society, it is recommended to determine the appropriate number of beds and physicians again in a few years with new data.