# Providing Safe Care to Older Hospitalized Patients through Discrete Event Simulation Modeling

> **NIH AHRQ R18** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2020 · $379,443

## Abstract

Project Summary
 Many hospital patients, particularly older patients, are dependent on staff for assistance with activities
of daily living (ADL) such as walking and toileting. Assistance with these activities is time-consuming for staff,
and evidence suggests that ADL assistance is not consistently provided in hospitals. This inconsistent ADL
care is often associated with adverse events, particularly falls, with 30-60% of hospital falls related to patients’
attempts to use the bathroom. There is evidence that consistent toileting and mobility assistance can prevent
falls, but barriers related to staffing and the complex hospital work environment make it difficult to provide this
care consistently in daily acute care practice.
 The National Academy of Medicine has identified a systems-engineering approach called Discrete
Event Simulation (DES) as a method to improve the quality and efficiency of health care. This approach has
been used for decades in other industries and more recently applied to healthcare settings. Discrete Event
Simulation mathematically models multiple work parameters that define a care setting, such as the time to
provide an episode of care, and predicts the ability of staff within that setting to provide care at different points
in time based on other competing demands and care requirements. Sensitivity and predictive analyses can be
used to examine how changes to the system, such as different staff schedules or order of care routines, affect
and improve care delivery thus facilitating more efficient management.
 This investigative team has applied DES to the nursing home setting to identify staffing needs to
provide care based on a range of resident ADL dependencies and staffing resources. However, this DES
methodology has not been applied to the acute care setting, where many older patients need similar ADL care
services and also are at risk for falls. Thus, the purpose of the proposed study is to apply DES to the hospital
setting focused on units that care for large numbers of older patients with ADL dependencies.
 This study will produce a novel technology that hospital providers may use to efficiently manage
medical units by experimenting with innovative approaches to improve ADL care prior to more expensive
efforts to implement and test interventions in actual practice. This technology will be first developed and tested
in an Acute Care for the Elderly (ACE) unit. However, the degree to which the model accurately describes care
in two other diverse hospital units will be tested in preparation for disseminating the model to other units and
hospitals via a web-based simulation tool.

## Key facts

- **NIH application ID:** 10005340
- **Project number:** 5R18HS025910-02
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** SANDRA F SIMMONS
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $379,443
- **Award type:** 5
- **Project period:** 2019-09-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10005340

## Citation

> US National Institutes of Health, RePORTER application 10005340, Providing Safe Care to Older Hospitalized Patients through Discrete Event Simulation Modeling (5R18HS025910-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10005340. Licensed CC0.

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