Planning of bed capacities in specialized and integrated care units: Incorporating bed blockers in a simulation of surgical throughput

Simulation has been applied for the management of bed capacities in hospitals. However, the majority of these studies have ignored the application of this technique in specalized and integrated care units, where-in different wards, e.g., general ward, Intensive Therapy Unit (ITU), High Dependency Unit (HDU), are organized to provide patients differing levels of care as they progress through the treatment pathway. In this set-up, bed blocking occurs when patients that are clinically ready to be discharged from wards that provide higher levels of care (e.g., ITU) cannot be transferred to wards offering reduced care (e.g., HDU, general ward) because of the non-availability of beds in the latter wards. This has implications on throughput of clinical activity, as well as patients´ cost of treatment. In this paper we investigate this problem of bed blocking through a case study being conducted at the Cardiac Intensive Care Unit at Morriston Hospital, Wales (UK).