The dynamics of local rules in hospital admission processes

Abstract

This paper reports on research into admission practices at a sub acute extended care hospital. A system dynamicssimulation model of the patient flow from feeder hospitals to the hospital was built to show the impact of the localrules used by the medical registrar. Local rules are behaviours that are local, and often idiosyncratic, adaptations tothe local environment. The model showed these adaptations had a significant impact on the acuity of patients beingadmitted as a result of the separation policies of the feeder hospitals. This patient mix in turn affected the hospitalability to meet its budget.