Improving Hospital Operations, One Bed at a Time

NEW YORK, April 29, 2019 /PRNewswire/ -- As hospitals continue to seek innovative ways to maximize efficiency and minimize wait times, Columbia Business School Professor Jing Dong and her colleagues have developed data-driven models that can help hospitals increase the number of admitted patients, decrease lengths of stay, and speed up discharge processes — all by focusing on the number of beds in the hospital.

"Given the high cost of operating hospitals, administrators need to pay more attention to the efficiency of their operations," says Professor Dong, a specialist in service operations management. "I think I'm in a unique position to help them look at whether there's room for improving that efficiency."

Hospital physicians typically conduct rounds once a day to examine whether patients are ready for discharge. In a study with Columbia Business Professors Linda Green and Carri Chan, the researchers found that hospitals can cut more than six hours off patients' average length of stay by conducting two rounds at specific times of the day.  The optimal time for a physician to conduct rounds is six hours before the peak patient influx, the professors found; if they're allowed to add a second inspection, it should be scheduled 12 hours later, according to their 2017 paper published in Operations Research. (Conducting any more inspections makes a marginal difference.)

Another way to reduce hospital congestion is by posting ER wait-time, as some hospitals are now doing. But this can backfire if hospitals are not constantly updating their information, as Professor Dong found in a study to be published in Management Science this year with Galit Yom-Tov of Technion and Elad Yom-Tov from Microsoft Research.  In their analysis of more than 200 hospitals that provide wait-time information, Professor Dong found that patients may act strategically to help balance the workload between hospitals. However, when the information is not up-to-date, strategic behavior of patients may worsen hospital congestion due to the delayed feedback effect.

Hospital can also add new beds to reduce congestion, although this introduces new costs. To find the optimal number of beds, Professor Dong teamed up with Ohad Perry of Northwestern University to develop a mathematical model that quantify the relationship between the number of beds and the quality of service for each inpatient unit.

Their paper, "Queueing Models of Patient-Flow Dynamics in Inpatient Wards," is to be published in Operations Research this year. Its findings could suggest dramatic cost-savings as well, since maintaining a single hospital bedroom costs about $1 million a year.  If patients can be safely discharged faster and more people can use the same bed over the course of a year, overall costs have the potential to come down.

In a related working paper, with Professor Fanyin Zheng of Columbia Business School, Pengyi Shi of Purdue, and Xin Jin of the Singapore National University Health System, Professor Dong zoomed in on what kind of hospital beds are most needed to increase overall operational efficiency. The researchers found that when patients are assigned a bed outside their primary specialty, there can be an associated 19 percent increase in their length of stay. They also found that by reallocating 6 percent of bed capacity, the hospital can reduce patient waiting time by more than 10 percent and save more than 2,000 patient days a year.

"A lot of the improvements are achieved by taking a network view of the hospital units," says Professor Dong. "These units are all interconnected, helping one unit do better will have a spillover effect to the others.  It's not so much about treatment of patients or clinical decisions, but how hospitals operate.  It's generating interesting research questions for me, but I also see how it could help hospitals save money and offer better quality of service to patients."

To learn more about the cutting-edge research taking place at Columbia Business School, please visit www.gsb.columbia.edu.

SOURCE Columbia Business School

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