Improving access to intermediate care through flexibility: Simulation study

Objective Growing demand for intermediate care, combined with nurse shortages, is increasing the pressure on the accessibility of these services. This study uses simulation as an innovative approach to assess the effectiveness of policy interventions on waiting times and hospital admissions, aiming to identify strategies that better meet rising care demands and improve accessibility. Design A discrete-event simulation study modeling patient flows in intermediate care facilities. Setting and Participants The simulation model incorporates insights from health care professionals to represent patient flows, admissions, bed capacities, and operational constraints across both intermediate care and hospital settings. Methods The simulation model incorporates patient arrivals, admissions, and discharges within intermediate care. The study evaluates the impact of the following interventions on patient flow and accessibility: bed pooling between care types, flexible admission hours and transfer times, and the use of emergency beds. Results Partial bed pooling (10%) between high-complex and geriatric rehabilitation beds reduces waiting times by more than 1 day (a 25% to 42% reduction). Currently, average waiting times are approximately 2 days for low-complex care, and around 4 days for both high-complex care and geriatric rehabilitation. Expanding admission hours, particularly with 24/7 availability, decreases waiting times and hospital congestion. Eliminating emergency beds increases hospital admissions by 18%. By implementing multiple interventions, such as bed pooling and 24/7 admissions, accessibility shows the greatest improvement, with waiting times for high-complex patients reduced by more than 2 days (a 60% reduction) and decreased hospital admissions by 60%. Conclusion and Implications This study illustrates that access to intermediate care can be improved through bed pooling, flexible admission hours and transfer times, and the use of emergency beds, without the need to expand bed capacity. The results demonstrate that these interventions can optimize patient flow, reduce hospital admissions, and enhance overall system efficiency. Furthermore, the study demonstrates that simulation models are valuable tools for exploring policy and system changes within intermediate care settings.

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