Title：Inpatient Discharge Planning: Approaches to Improve Patient Flow and Reduce Upstream Boarding
Time：14:00 to 16:00, July.17, 2019
Place：F203, School of Mechanical Engineering
Host：LI Na, Associate Professor (Department of Industrial Engineering and Management)

Biography
Pratik J. Parikh is a Professor of Industrial and Systems Engineering at Wright State University (WSU) in Dayton, OH. He also has joint appointments in Surgery and Computer Science. He received his PhD from Virginia Tech in 2006 and worked in industry before joining WSU in early 2009. His primary research interests are in healthcare systems engineering with focus on trauma care and network design, inpatient discharge planning, and outcomes prediction. His research in healthcare has been supported by over $2.2 million in grants and contracts from the NSF, New England Veterans Engineering Resource Center, the Veterans Affairs, the State of Ohio, and industry. He regularly collaborates with physicians, nurses, EMS and inpatient care providers, and health services researchers at academic institutions and state agencies. Besides healthcare, Dr. Parikh is also involved with research in supply chain and retailing. He is currently the President-Elect of the Logistics and Supply Chain Division at IISE and Chair of the Facility Logistics SIG/TSL at INFORMS. His contributions have been recognized with Best Paper Awards at IISE Annual Meetings (2017, 2018, 2019), INFORMS Volunteer Service Award (2018), and Outstanding Faculty Advisor Award from IISE (Great Lakes Region, 2014). His collective contributions in research, education, and service have been recognized by the Dayton Forty Under 40 Award (2019), Affiliates Societies Council of Dayton's Outstanding Researcher and Scientist Award (2017), and several awards at WSU including the WSU President's Early Career (2014), College Outstanding Faculty (2016), and College Faculty Research Excellence (2019).

Abstract
Discharge planning in an inpatient unit at a hospital involves coordination between members of a care team from various clinical services to ensure smooth transition of a patient from the unit to a downstream facility (home or long term care). Recent research suggests that an effective way to increase the efficiency of hospital patient flow is by better synchronizing inpatient discharges with upstream admissions. Inefficient discharge planning can result in discharge delays that increase the length of stay of discharge-ready patients and contribute to upstream patient boarding. Excessive boarding will tie up a bed in such upstream units leading to crowding, especially in the emergency department (ED).

In this talk, we will discuss two specific challenges in inpatient discharge planning. First, we propose a novel target discharge strategy, the n-by-T strategy, which refers to discharging n patients by the Tth hour of the day. We demonstrate the effectiveness of this strategy via a simulation study, which suggests nearly 2 hr of advancement in the mean discharge time and nearly 15% reduction in upstream boarding. We will also discuss findings from a pilot implementation of this strategy at a local hospital and potential generalizability of this approach.

Second, we will discuss the importance of a key bottleneck resource at many inpatient units, the ancillary service providers (ASPs), who often impact daily discharges. ASPs include social workers, care managers, and physical and occupational therapists. Although well-recognized in healthcare industry, but under-studied in academic research, the sequence in which these ASPs process discharge-ready patients alongside current and newly-arriving patients can have a substantial impact on the patient flow in the unit. We model this problem as a stochastic single machine sequencing problem with side constraints. Using a simulation-optimization approach, we derive near-optimal policies and benchmark industry practice.