Bagust A, Place M, Posnett J W
York Health Economics Consortium, University of York, Heslington, York YO10 5DD.
BMJ. 1999 Jul 17;319(7203):155-8. doi: 10.1136/bmj.319.7203.155.
To examine the daily bed requirements arising from the flow of emergency admissions to an acute hospital, to identify the implications of fluctuating and unpredictable demands for emergency admission for the management of hospital bed capacity, and to quantify the daily risk of insufficient capacity for patients requiring immediate admission.
Modelling of the dynamics of the hospital system, using a discrete-event stochastic simulation model, which reflects the relation between demand and available bed capacity.
Hypothetical acute hospital in England.
Simulated emergency admissions of all types except mental disorder.
The risk of having no bed available for any patient requiring immediate admission; the daily risk that there is no bed available for at least one patient requiring immediate admission; the mean bed occupancy rate.
Risks are discernible when average bed occupancy rates exceed about 85%, and an acute hospital can expect regular bed shortages and periodic bed crises if average bed occupancy rises to 90% or more.
There are limits to the occupancy rates that can be achieved safely without considerable risk to patients and to the efficient delivery of emergency care. Spare bed capacity is therefore essential for the effective management of emergency admissions, and its cost should be borne by purchasers as an essential element of an acute hospital service.
研究急症医院急诊入院流量所产生的每日床位需求，确定急诊入院需求波动和不可预测性对医院床位管理的影响，并量化急需入院患者面临床位不足的每日风险。
使用离散事件随机模拟模型对医院系统动态进行建模，该模型反映了需求与可用床位之间的关系。
英国一家假设的急症医院。
模拟除精神障碍外的所有类型的急诊入院情况。
任何急需入院患者无床位可用的风险；至少有一名急需入院患者无床位可用的每日风险；平均床位占用率。
当平均床位占用率超过约85%时，风险明显可见，如果平均床位占用率升至90%或更高，急症医院预计会经常出现床位短缺和周期性床位危机。
在不对患者和高效提供急诊护理造成相当大风险的情况下，安全可实现的占用率是有限的。因此，备用床位容量对于有效管理急诊入院至关重要，其成本应由购买方承担，作为急症医院服务的一个基本要素。
