Exploring financially sustainable initiatives to address out-of-area placements in psychiatric ICUs: a computer simulation study.

BACKGROUND: Transferring individuals for treatment outside their geographic area occurs when healthcare demand exceeds local supply. This can result in significant financial cost while impacting patient outcomes and experience. AIMS: The aim of this study was to assess initiatives to reduce psychiatric intensive care unit (PICU) out-of-area bed placements within a major healthcare system in South West England. METHODS: Discrete event computer simulation was used to model patient flow across the healthcare system's three PICUs. A scenario analysis was performed to estimate the impact of management plans to decrease admissions and length of stay. The amount of capacity required to minimise total cost was also considered. RESULTS: Without increasing in-area capacity, mean out-of-area bed requirement can be reduced by 25.6% and 19.1% respectively through plausible initiatives to decrease admissions and length of stay. Reductions of 34.7% are possible if both initiatives are employed. Adjusting the in-area bed capacity can also lead to aggregate cost savings. CONCLUSIONS: This study supports the likely effectiveness of particular initiatives in reducing out-of-area placements for high-acuity bedded psychiatric care. This study also demonstrates the value of computer simulation in an area that has seen little such attention to date.