Hospital bed utilization: an implemented simulation approach to adjusting and maintaining appropriate levels.

A simulation model was constructed to permit detailed assessment of bed allocation and usage rules, thereby easing considerably the process of improving and maintaining appropriate utilization levels. The model, written in Simscript II.5, follows patient processing from preadmission through discharge, uniquely identifying patients, beds, diagnosis-related service areas, and so on, permitting reliable evaluation of bed usage performance. It was applied at The Mount Sinai Hospital, New York City. Using the model, several bed allocation plans were developed, one being adopted as the best-case reallocation. Also studied was the impact of severely restricting off-service patient placements. Additionally, the work resulted in a new service being established, a realignment of elective admissions reservations, and the incorporation of an additional measure of performance. The article discusses bed utilization problems in general and, in particular, the simulation model, the performance measures used, the experiments undertaken, the results achieved, the then-current and best-case allocation plans, and some directions for future work.