Inpatient demand for services during a
pan flu event may overwhelm existing
hospital supply
• Intensive Care Unit (ICU) and
Medical/Surgical (Med/Surg) beds
• Supply of staff and equipment
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Presented by Andrew Barnes PhDc
Co-authors: Jerry Jacobson, PhD, Heather Kun,
PhD, Matt Solomon, MD, PhD
National Health Foundation
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Staff attrition
Ventilators
National Health Foundation 2009
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LA County Department of Public Health funded
NHF to
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Model inpatient hospital supply during a pan flu
event
Frame a set of policy options the County may have
to implement during an outbreak to temporarily
increase supply
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A Queuing model
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A micro-simulation
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Stochastic
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Patients wait to be served in beds
Uses patient level data
Includes randomness to account for variation and
uncertainty in estimates
Discrete event
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Models events that either happen or don’t
National Health Foundation 2009
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Software
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Data sources
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Pan Flu
Moderate
Moderate
California Office of Statewide Health Planning and
Development
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Baseline
Extend 5.0
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National Health Foundation 2009
Hospital Financial Data Sets
Patient Discharge Data Sets
Hospital Utilization Data Sets
US Census
California Department of Finance
Flu Surge 2.0
University of Washington Los Angeles Community Flu Model
National Health Foundation 2009
Severe
Severe
No Intervention
Pan Flu
Moderate
Moderate
Severe
Severe
InterventIon
↓ Elective Admits
↑ Bed Supply
Ignore Payer Status
Inpatient Capacity
• Occupancy Rates
• Total Patient Days
• Demand Exceeding Supply
National Health Foundation 2009
1. Reduce elective admissions (REA)
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Probabilities were created that a pending elective will be
denied admission based on hospital and bed type
2. Increase hospital bed supply (IBS)
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Step 1
Hybrid of ICU and Med/surg beds called acute respiratory
support beds
Patients
Patients Need
Need Care
Care
3. Ignore payer status (IPS)
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Create Patients
Seeking Hospital
Services
If a hospital is full patients can go to the nearest hospital
irrespective of their insurance type
Step 2
Step 3
Find
Find A
A Hospital
Hospital
Assign Patients Assign Patients
a Bed and
a Hospital
Length of Stay
National Health Foundation 2009
Scenario
Ed Vis
Pt Days
Can’t Find
Bed – ED
Can’t Find
Bed – IP
Leave ED
w/o Tx
Ventilator
Demand
No Flu
1,351,937 1,794,056 5,437 271
3,516 14,290 Mod Flu
1,553,780
1,879,311 29,406 2,278 21,170 15,648 1,545,198 1,851,826 24,098 2,178 19,015 15,345 1,846,601 2,126,337 93,468
4,448 88,469 16,500 1,828,675 1,962,883 80,574
3,510 78,935 15,594 REA+IBS
Svr Flu
REA+IBS
National Health Foundation 2009
Find
Find A
A Bed
Bed
National Health Foundation 2009
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In a severe flu scenario, nearly 200,000
patients who need care will not receive it
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Many of these require ICU level care
Proposed interventions do not add enough
supply to meet the demand
Modeling multiple hospitals and EDs captures
interconnectedness of patient flow,
fluctuations in demand, and congestion
throughout the County
National Health Foundation 2009