Academic journal article Iranian Journal of Public Health

Bed Capacity Planning Using Stochastic Simulation Approach in Cardiac-Surgery Department of Teaching Hospitals, Tehran, Iran

Academic journal article Iranian Journal of Public Health

Bed Capacity Planning Using Stochastic Simulation Approach in Cardiac-Surgery Department of Teaching Hospitals, Tehran, Iran

Article excerpt


In recent years, research on the hospital planning and related topics including bed planning methods, operating theater scheduling, and waiting lists has been interested (1). For example bed capacity estimation is an interesting and key issue in hospital bed management (2). Bed management process includes patient experience, bed allocation, and, bed capacity planning. A suitable bed management method can help reduce patient's waiting time and decrease canceled surgeries because of hospital beds blocking. Note that the balance of bed capacity and clinical processes can produce suitable outcomes for patients (3).

Today, different literatures relating to hospital bed planning and patient flow problems are increasing in the worldwide (4). Hospital bed capacity estimation is a complex issue because patient's stay and arrival of patients to a hospital is a stochastic process. There are also many kinds of hospital stays (from long-term to short-term) and several specialties each with its case management profile. Length of hospital stay is a key parameter for bed capacity modeling (5, 6). Optimizing the hospital length of stay is promising alternative for efficient consumption of hospital beds and other recourses (7, 8). Length of stay indicator is used for various purposes such as management of hospital care, quality control, and appropriateness of hospital resource use, bed management, and hospital planning (9).

Bed estimation and allocation is a macro-level type decision. A planned bed allocation to the different medical and surgical specialties is an important decision for hospital management. Today, researchers and planners use the simulation models for hospital bed capacity planning (10). A simulation can be used to response 'whatif?' in the basis of simulation models we can produce various scenarios for decision-making (11). Simulation is an appropriate tool for evidencebased decision making in complicated and uncertain systems such as health systems. This technique provides possible solutions through modeling (12)-14). In the recent decades, Simulation approach has been used to solve problems of health care sector and hospitals (13, 14). Using simulation approaches to improve health care systems has been facing with challenges and there are some barriers to implementation of simulation models (4, 11).

In different studies of health care system, researchers have used the mathematical simulation models including dynamic, static, deterministic, and stochastic models (15). Some of these simulation models can be used for hospital bed planning. One study describes three frequent simulation models for hospital planning; First, Discrete Event Simulation (DES), Second, System Dynamics (SD), Third, Agent-Based Simulation (ABS) that is a simulation method for modeling dynamic and autonomous systems (11).

Some studies recommended a mixed method to determine and estimate required resources of hospitals (10). Another study used stochastic simulation method to assess the number of beds required for gynecology departments in a university hospital in Tehran, Iran (18). Simulation methods and managerial scenarios are useful tools for hospital beds estimation (19).

Deterministic approaches cannot be used to assess requirements of complex and dynamic systems such as hospitals (16). Because Patient's arrival rate and its length of hospital stay, are stochastic processes (2, 10).

The main purpose of this study was to estimate hospital beds using stochastic simulation approach in cardiac surgery department of teaching hospitals.


Design and setting

This cross-sectional study was conducted in cardiac surgery department of Imam Khomeini and Shariati hospitals that belong to Tehran University of medical sciences, Iran. These are two teaching and large hospitals with 970 and 570 beds, respectively. Imam Khomeini hospital had 18 cardiac surgery beds, 8 cardiac surgery intensive care units and 39 cardiology beds. …

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