Design of Observation Units for Acute Decompensated Heart Failure Patients

In light of reported benefits, including reduced unnecessary hospitalization as well as post-discharge events, an increasing number of hospitals are considering the option of introducing observation units for acute decompensated heart failure patients. While implementing this strategy, the hospital administrators face the questions of (i) whether it is cost effective to create an observation unit; (ii) if so, what the capacity of the observation unit should be; (iii) which optimal admission and discharge policies would improve the efficiency of these units under a given capacity. The objective of paper is to propose a two-phase methodological framework to design an observation unit for acute decomposition heart failure patients in order to provide insights for these questions. In the first phase, by studying the various patient volumes and arrival patterns based on a data set from a large secondary hospital, we investigate the optimal capacity regarding the number of beds to be installed in an observation unit through analyzing multiple analytical models. In the second phase, we study the possible admission and discharge policies for this observation unit with a fixed capacity. We assess each policy under various quality of care and cost criteria including probability of post-discharge events, likelihood of hospitalization, the total cost and cost-gain ratio. We provide managerial insights for hospital administrators through extensive numerical experiments.