Simulated co-location of patients admitted to an inpatient internal medicine teaching unit: Potential impacts on efficiency and physician-nurse collaboration

Abstract

This presentation reports the results of a study to increase physician-to-patient time in the internal medicine (IM) unit at University Hospital in London, Canada, by reducing the incidence of two sources of inefficiency. Currently, three physician teams operate on the IM unit, with each team’s patients spread over two floors. The project proposed changes to the bed assignment method to geographically co-locate each team’s patients in a contiguous area. This thrust would also reduce inefficiency in the number of nurses a physician collaborates with for the same patient load, as nurses are generally assigned to patients in adjacent rooms. This improved efficiency during physician-nurse interactions will lead to better patient care. The other novel aspect to the project was the hybrid assignment of patients to teams. Each patient will be assigned to the first available bed, and the initial proxy for this upon patient admission is the team with the lowest census level. Occasionally, the first available bed will belong to another team, in which case a change of medicine team will occur. A simulation model of the ward was developed specifically to test these changes, and the results presented suggest an implementation will achieve these goals without impacting patient waiting time or occupancy levels. Two new metrics defined to quantify the impacts of the new assignment method were a) the relative number of nurses each medicine team has assigned to their patients, as well as b) the variation between the total number of patients assigned to each team. Simulation results show that the hybrid assignment minimized this variation, while the number of nurses a team has to interact with is significantly reduced.