Using probabilistic patient flow modelling helps generate individualised intensive care unit operational predictions and improved understanding of current organisational behaviours

Purpose We sought a bespoke, stochastic model for our specific, and complex ICU to understand its organisational behaviour and how best to focus our resources in order to optimise our intensive care unit’s function. Methods Using 12 months of ICU data from 2017, we simulated different referral rates to find the threshold between occupancy and failed admissions and unsafe days. We also modelled the outcomes of four change options. Results Ninety-two percent bed occupancy is our threshold between practical unit function and optimal resource use. All change options reduced occupancy, and less predictably unsafe days and failed admissions. They were ranked by magnitude and direction of change. Conclusions This approach goes one step further from past models by examining efficiency limits first, and then allowing change options to be quantitatively compared. The model can be adapted by any intensive care unit in order to predict optimal strategies for improving ICU efficiency.

Specialty Location Decisions in the Reformed NHS: A Case Study

A soft systems approach, largely based on soft systems methodology, was used to steer a study (completed in 1996) of the National Health Service contracting process. It led to action research projects on a number of related issues. One such area that emerged very strongly concerns service rationalization and service planning, and in particular the location of ‘small’ specialties. A Trust-based study involving patient flow modelling demonstrates the form these problems can take within the internal market and highlights the challenge they make to the contracting process or the new primary care group based commissioning process if they are to be resolved in a rational manner.