Balancing scarce hospital resources during the COVID-19 pandemic using discrete-event simulation

Health Care Manag Sci. 2021 Jun;24(2):356-374. doi: 10.1007/s10729-021-09548-2. Epub 2021 Apr 9.


COVID-19 has disrupted healthcare operations and resulted in large-scale cancellations of elective surgery. Hospitals throughout the world made life-altering resource allocation decisions and prioritised the care of COVID-19 patients. Without effective models to evaluate resource allocation strategies encompassing COVID-19 and non-COVID-19 care, hospitals face the risk of making sub-optimal local resource allocation decisions. A discrete-event-simulation model is proposed in this paper to describe COVID-19, elective surgery, and emergency surgery patient flows. COVID-19-specific patient flows and a surgical patient flow network were constructed based on data of 475 COVID-19 patients and 28,831 non-COVID-19 patients in Addenbrooke's hospital in the UK. The model enabled the evaluation of three resource allocation strategies, for two COVID-19 wave scenarios: proactive cancellation of elective surgery, reactive cancellation of elective surgery, and ring-fencing operating theatre capacity. The results suggest that a ring-fencing strategy outperforms the other strategies, regardless of the COVID-19 scenario, in terms of total direct deaths and the number of surgeries performed. However, this does come at the cost of 50% more critical care rejections. In terms of aggregate hospital performance, a reactive cancellation strategy prioritising COVID-19 is no longer favourable if more than 7.3% of elective surgeries can be considered life-saving. Additionally, the model demonstrates the impact of timely hospital preparation and staff availability, on the ability to treat patients during a pandemic. The model can aid hospitals worldwide during pandemics and disasters, to evaluate their resource allocation strategies and identify the effect of redefining the prioritisation of patients.

Keywords: COVID-19; Capacity management; Intensive care; Operations research; Resource allocation; Simulation.

MeSH terms

  • COVID-19*
  • Critical Care
  • Efficiency, Organizational*
  • Elective Surgical Procedures
  • Equipment and Supplies, Hospital / supply & distribution*
  • Hospitals*
  • Humans
  • Operating Rooms
  • Pandemics*
  • Resource Allocation* / methods
  • SARS-CoV-2
  • United Kingdom