A system dynamics view of the acute bed blockage problem in the Irish healthcare system

Global population ageing is creating immense pressures on hospitals and other healthcare services, compromising their abilities to meet the growing demand from elderly patients. Current demand–supply gaps result in prolonged waiting times in emergency departments (EDs), and several studies have focused on improving ED performance. However, the overcrowding in EDs generally stems from delayed patient flows to inpatient wards – which are congested with inpatients waiting for beds in post-acute facilities. This problem of bed blocking in acute hospitals causes substantial cost burdens on hospitals. This study presents a system dynamics methodology to model the dynamic flow of elderly patients in the Irish healthcare system aimed at gaining a better understanding of the dynamic complexity caused by the system's various parameters. The model evaluates the stock and flow interventions that Irish healthcare executives have proposed to address the problem of delayed discharges, and ultimately reduce costs. The anticipated growth in the nation's demography is also incorporated in the model. Policy makers can also use the model to identify the potential strategic risks that might arise from the unintended consequences of new policies designed to overcome the problem of the delayed discharge of elderly patients. •An application of system dynamics in examining bed blockage at Irish hospitals.•Implications of future demands including changes in demography are considered.•Interventions using stock (post-acute beds) and flow (elderly patients) policies.•Increasing capacity in post-acute beds is a counter-intuitive policy.•Integrated solution is required to mitigate the bed blockage problem at large.