Hospital bed capacity management /

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Bibliographic Details
Author / Creator:Best, Thomas Joseph, author.
Imprint:2015.
Ann Arbor : ProQuest Dissertations & Theses, 2015
Description:1 electronic resource (194 pages)
Language:English
Format: E-Resource Dissertations
Local Note:School code: 0330
URL for this record:http://pi.lib.uchicago.edu/1001/cat/bib/10773112
Hidden Bibliographic Details
Other authors / contributors:University of Chicago. degree granting institution.
ISBN:9781321887068
Notes:Advisors: Donald D. Eisenstein; Burhaneddin Sandikci Committee members: Baris Ata; Donald D. Eisenstein; Varun Gupta; David O. Meltzer; Burhaneddin Sandikci.
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Dissertation Abstracts International, Volume: 76-11(E), Section: B.
English
Summary:The purpose of this work is to understand and improve the practice of hospital bed management from both the hospital and the societal perspectives. The approach is to develop and solve quantitative decision support models which allow practitioners to estimate and compare many potential bed capacities within their contexts.
Chapter 1 considers the partitioning of care types into wings from the perspective of a hospital administrator who wishes to optimize the use of a fixed number of beds that provide services for heterogeneous care types. The administrator faces an inherent trade-off between forming large wings to pool demand and bed capacity, and forming specialized wings to focus on narrow ranges of care types. Specialized wings not only provide advantages from focused care, but also allow the protection of beds for high utility care types. We provide an optimization model for the wing formation decision and address the advantages of focus endogenously in our model. Using data from a large urban teaching hospital in the US along with a national database, we report on a number of insights. As overall demand increases, more wings are formed to reserve beds for higher utility types, which improves hospital utility but causes disparities in patient access. We also observe that when patients are willing or able to wait longer for admission, the hospital can afford to form more wings and thereby benefit from focused care.
Chapter 2 assumes the perspective of a public planner who wishes to identify bed capacities for multiple hospitals which minimize the societal costs from bed shortages and surpluses. We scrutinize the current methods of US state governments for setting cost-minimizing bed capacity targets, and we reveal a number of flaws. To resolve these flaws, we introduce a general modeling framework and conduct numerical experiments to compare its results to current bed targets. In general, our findings suggest that current targets tend to overestimate the number of beds necessary to achieve minimal societal costs. However, our results are preliminary; additional research is necessary before the framework can be applied to realistic problem instances.