The impact of hourly discharge rates and prioritization on timely access to inpatient beds

We develop an empirically calibrated hospital-wide simulation model to represent a time-varying, multiserver queuing network with multiple patient classes. The focus is on quantifying the impact of discharge profiles to alleviate inpatient bed congestions. A discharge profile is defined by (a) discharge window, which specifies hours of the day discharges are allowed; and (b) the maximum capacity for discharges in each hour of the window. Results of our simulation model show that a more responsive policy that prioritizes discharges in units with longer admission queues can significantly reduce waiting times (40% reduction in queues). In comparison, an early in the day discharge policy has a lower impact on improving bed congestions; we also find that early in the day discharges are very hard to realize in practice. Further, expanding the discharge windows by only 2 hours in the evening (7-9 PM) creates the same benefit, and is more realistic.