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Decreasing waiting time for mental health patients at Victoria hospital

Mesman, S.P.M. (2017) Decreasing waiting time for mental health patients at Victoria hospital.

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Abstract:This report investigates the waiting time for adult mental health patients at the Victoria hospital in London, Ontario. The hospital is an acute care hospital, and it handles around 180 emergency patient arrivals per day, of which 7.2% are mental health patients. It also has an Inpatient Psychiatry department where adult mental health patients that need hospital admission stay and receive treatment. The mental health patients at Victoria hospital encounter significant waiting time, especially if they end up getting admitted to Inpatient Psychiatry. The Inpatient Psychiatry department operates at 93% bed utilization which is quite high for a department with inherently variable (non-elective) patient arrivals and length of stay. Patients often need to wait a long time before they can enter a bed at Inpatient Psychiatry: on average 1.5 days (90th percentile 3.5 days). The lack of capacity in community support resources and at the Parkwood institute lead to more patient arrivals, and more long-term stay patients at Inpatient Psychiatry. Because of this additional workload the beds are often full, which means patients are waiting for a bed while in the Emergency department, which decreases the capacity there. The impact of the quite extreme long length of stay of ALC patients leads to substantial use of bed capacity that cannot be used to help other patients. In a one-year period from 2015 – 2016, 10% of the bed days were used by ALC patients. In the current situation the waiting time for adult mental health patients at Victoria is quite high, especially the time to bed when a patient is admitted to Inpatient Psychiatry. The objective of this study is to identify interventions that decrease the waiting times for adult mental health patients at Victoria hospital. In order to determine how to decrease the waiting time for adult mental health patients the current system is evaluated. The pattern of patient admissions and the length of their stay at Inpatient Psychiatry is analyzed, and based on the characteristics we develop a discrete event simulation model. Because of the high time to bed the scope of the model is the Inpatient Psychiatry department, starting with admission, until discharge. Based on the analysis of the current system, interviews with hospital staff, and similar case studies from literature we propose four interventions to decrease the waiting time. The estimated impact of these interventions is evaluated with the developed computer simulation model. The main factors that contribute to the waiting time of mental health patients are: the number of patient admissions to Inpatient Psychiatry, for how long the patients stay at the ward, and the number of patients that can be helped (admitted) simultaneously. The fact that these factors influence the waiting time is expected, however the impact that even relatively small changes have on the waiting time is surprising. Even a 1% or 2% decrease in the number of patient admissions to Inpatient Psychiatry is expected to decrease the average time to bed by approximately 6 – 10 hours. Decreasing the time patients spend at the ward by 1% or 2% has a similar impact. The impact of ALC patients on the capacity of Inpatient Psychiatry is substantial. Significant decreases in waiting time are achieved if patients would never stay for longer than 300, 200, or 100 days. If no patients would stay for longer than 100 days, the average time to bed is expected to decrease by approximately 90%. If the number of patient admissions or the length of their stay at the ward cannot be decreased, a third option exists. The waiting time is also reduced by adding additional beds, but it is a very expensive option. Even small reductions of the number of patient admissions or the time they stay at Inpatient Psychiatry will decrease the ‘time to bed’, and reduce overall waiting time. Never having patients stay for more than 100 days is estimated to lead to an approximate 90% reduction of waiting time for adult mental health patients, so reduction of ALC days is a high priority. However, at a system level more resources might be needed outside Victoria hospital in order to further reduce ALC days. Esensoy & Carter (2015) have created a quantitative model to look at patient flow at the LHIN level. Performing such a study to analyze the bigger picture might be useful to identify the bottlenecks in the system and get support to fix those problems. Performing a more detailed study on the Inpatient Psychiatry department might identify (administrative) inefficiencies. The patient can stay for shorter times while also remaining or improving in quality of care if such improvements are identified. Important is to carry out such an analysis with regards to quality of care. Another area of interest is the waiting time and length of stay for regular mental health patients and PICU patients at Inpatient Psychiatry. In interviews staff indicated mental health patients that need a PICU bed at Inpatient Psychiatry need to wait for longer than regular patients. No data is currently retained on the waiting times and length of stay split over PICU or regular patients.
Item Type:Essay (Bachelor)
Faculty:ET: Engineering Technology
Subject:56 civil engineering
Programme:Industrial Engineering and Management BSc (56994)
Link to this item:http://purl.utwente.nl/essays/74553
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