Optimization of the Patient Flow in a Forensic Psychiatric Hospital with Discrete Event Simulation

Abstract

We consider a forensic psychiatric hospital with multiple wards and forensic commitment patients as well as emergency patients arriving. Forensic commitment patients are awaiting their treatment outside the hospital, and are called in when a treatment place becomes available. Typically, forensic psychiatric hospitals have relatively few treatment places leading to long waiting lists and significant waiting times. Emergency patient arrivals arise due to crisis interventions and occur at random points in time. Forensic psychiatric hospitals are faced with the challenge of matching treatment programmes and security precautions to patients’ psychosocial abilities and risk potential while maximizing patient flow in order to cover costs. We develop a discrete event simulation model and identify effective patient allocation strategies to optimize patient flow, considering treatment adequacy, occupancy of all wards, average waiting times inside and outside the hospital and rejection rates of patient arrivals. Based on real-life data we evaluate various future scenarios and provide valuable decision support.