The dynamics of local rules in hospital admission processes.

This paper reports on research into admission practices at a sub acute extended care hospital. A system dynamics simulation model of the patient flow from feeder hospitals to the hospital was built to show the impact of the local rules used by the medical registrar. Local rules are behaviours that are local, and often idiosyncratic, adaptations to the local environment. The model showed these adaptations had a significant impact on the acuity of patients being admitted as a result of the separation policies of the feeder hospitals. This patient mix in turn affected the hospital ability to meet its budget.