The Impact of a Discharge Holding Area on the Throughput of a Pediatric Unit

Hospital patients often move from one bed to another for both medical and nonmedical reasons. In a highly utilized quaternary inpatient pediatric unit we have studied, bed and nursing resources are stressed not only by frequent movement of patients but also by the unit’s patient discharge policy. We present a discrete-event simulation model for examining how the unit’s efficiency may be improved by a better discharge policy. In particular, we use the base version of the model to investigate the impact of sending various percentages of discharge-ready patients to a discharge holding area where they can safely wait for a few hours until being picked up by their parent or guardian. Doing so frees up inpatient beds, allowing the unit to serve many more pediatric patients per year. In a revised version of the model we quantify the benefits of helping some patients achieve discharge-ready status a few hours earlier than under current operations. In both cases, our cost analysis shows that the unit could realize hundreds of thousands of dollars more per year in net revenue. This argument can be used to help persuade decision makers, who have otherwise been skeptical of the idea of a discharge holding area.