Clustered Overflow Configuration - a new approach to ward management that could reduce hospital bed shortages

National health care systems all over the world experience strain on the availability of inpatient beds. Investment in additional beds is not always feasible, so new and creative solutions for a more efficient use of existing resources must be sought.

The shortage of inpatient beds is a major cause of treatment delay and cancellation in hospitals. It can also result in lower quality of care and a longer length of stay for those patients allocated to contingency wards.

Currently, hospital bed allocation is often arranged on whether there is available space in a ward that has the specialist qualifications and facilities to meet the patient's requirements. This can be viewed as a 'dedicated' approach. Some hospitals operate a 'flexible' configuration, where individual wards contain a range of specialities. The 'dedicated' approach has the advantage of providing focused care, where the 'flexible' approach offers the benefits of 'pooling'. The disadvantage of the dedicated configuration is that patients are turned away (or forced to wait) when their primary ward is full, even if empty beds are available elsewhere within the hospital. Lesser focus of care, potentially leading to increased lengths of stay, may offset the benefits of pooling that come with the flexible approach.

Researchers at Cass Business School and Zagazig University propose a new configuration of inpatient beds, which it refers to as the 'clustered overflow configuration'. With this configuration the advantages of the 'dedicated' and 'flexible' approaches can be combined.

In the proposed model, specialisms are partitioned into a number of clusters. Each cluster includes a dedicated ward for each of the specialisms in the cluster as well as a single shared ward, called the overflow ward. The overflow ward of each cluster is staffed with multi-skilled nursing teams capable of caring for all of the requirements in the cluster. Patients whose primary ward is fully occupied are admitted to the cluster's overflow ward.

The clustered overflow configuration inherits the advantages of focused care in its dedicated wards. It also utilises the benefits of pooling in its overflow wards, and minimises mix variability and cross-training costs. The research findings suggest it could serve as a viable alternative to existing inpatient configurations.

The paper A Clustered Overflow Configuration of Inpatient Beds in Hospitals is available for download at City Research Online. It has been published in Manufacturing and Service Operations Management.

Dr Navid Izady has also developed a model which pools intensive care unit (ICU) facilities to improve care for Covid-19 patients.