Performance evaluation of an integrated care for geriatric departments using discrete-event simulation

The increasing number of geriatric patients is one of the most important problems for the next years. This kind of patients is often dependent and does not tolerate environment changes so that hospitalization can strongly deteriorate the elderly health state. This paper focuses on two services of the geriatric services: the Short Stay (Acute Care) and Rehabilitative Care (to prepare the return at home). We use Discrete Event Simulation to compare two different configurations (integrated care vs separated) based on two French hospitals case studies. In the integrated configuration both services are located in the same department and in the separated configuration services are independent. We measure the impact of these organizations on the occupancy, admissions, waiting and the total length of stay. We also study the economic impact based on the French funding system taking into account the Diagnosis Related Group of the patient.