Effective Response to Hospital Congestion Scenarios: Simulation-Based Evaluation of Decongestion Interventions.

Hospital overcrowding is becoming a major concern in the modern era due to the increasing demand for hospital services. This study seeks to identify effective and efficient ways to resolve the serious problem of congestion in hospitals by testing a range of decongestion strategies with simulated scenarios. In order to determine more efficient solutions, interventions with smaller changes were consistently tested at the beginning through a simulation platform. In addition, the implementation patterns were investigated, which are important to hospital managers with respect to the decisions made to control hospital congestion. The results indicated that diverting a small number of ambulances seems to be more effective and efficient in congestion reduction compared to other approaches. Furthermore, instead of implementing an isolated approach continuously, combining one approach with other strategies is recommended as a method for dealing with hospital overcrowding.

A virtual evaluation of options for managing risk of hospital congestion with minimum intervention.

Hospital congestion is a common problem for the healthcare sector. However, existing approaches including hospital resource optimization and process improvement might lead to huge cost of human and physical structure changes. This study evaluated less disruptive interventions based on a hospital simulation model and offer objective reasoning to support hospital management decisions. This study tested a congestion prevention method that estimates hospital congestion risk level (R), and activates minimum intervention when R is above certain threshold, using a virtual hospital created by simulation modelling. The results indicated that applying a less disruptive intervention is often enough, and more cost effective, to reduce the risk level of hospital congestion. Moreover, the virtual implementation approach enabled testing of the method at a more detailed level, thereby revealed interesting findings difficult to achieve theoretically, such as discharging extra two medical inpatients, rather than surgical inpatients, a day earlier on days when R is above the threshold, would bring more benefits in terms of congestion reduction for the hospital.

Medication prescription among elderly patients admitted through an acute assessment unit.

AIM: This study assessed medication use patterns and polypharmacy in patients who were admitted through an acute assessment unit (AAU) and stratified results according to patient age. This study also examined risk factors associated with polypharmacy and consequences of polypharmacy, namely prescription writing errors, drug-drug interaction and geriatric syndrome. METHODS: The medication charts and admission notes of 200 consecutive patients admitted through the AAU over a period of 1 month were retrospectively reviewed. Data were collected on patients' demographics, comorbidities, types and number of medications, hospital length of stay and reason(s) for presentation. Potentially harmful prescription errors or errors necessitating intervention were also recorded, as were any potential adverse drug-drug interactions. RESULTS: Medications for the treatment of disorders of the cardiovascular (46% of total patients) and nervous systems (30%) predominated. Of the 200 patients reviewed, 158 were aged ≥ 65 years and their mean serum creatinine was higher than those aged < 65 years (100.9 ± 54.0 vs. 79.9 ± 45.9 µmol/L, P = 0.01), 81% were taking five or more concurrent regular medications at the time of admission. Of all 200 patients, 28% suffered renal impairment, defined as creatinine > 100 µmol/L for women and > 120 µmol/L for men. The presence of more than two comorbidities (odds ratio (OR) 6.80; 95% confidence interval (CI) 2.89-16.00; P < 0.001) and age (OR 2.91; 95% CI 1.24-6.80; P = 0.01), were factors associated with polypharmacy. Excessive polypharmacy was associated with an increased risk of prescription errors that could cause temporary harm or required intervention (OR 5.23; 95% CI 1.39, 19.69; P = 0.009) but was not associated with a prolonged length of stay. CONCLUSIONS: This study showed that polypharmacy and renal impairment are prevalent amongst elderly patients admitted through an AAU. Polypharmacy in the elderly is attributable to greater comorbidities and is associated with an increased risk of adverse consequences. To avoid inappropriate medication use and improve the quality of prescription among those with polypharmacy, careful review of elderly patients' drugs is needed while they are in the AAU.