Step-down unit discharge delays

1. System failure identification

   Intensive care patients ready for step-down wait in intensive care beds because no step-down bed is free. The constraint sits one level downstream, but the cost appears as an intensive care capacity problem. The most expensive bed in the hospital is held by a patient who no longer needs it.

2. Data pipeline diagnostics

   Each unit reports its own occupancy. Nothing models the chain, so an intensive care unit at capacity and a step-down unit at capacity look like two separate problems rather than one queue. Local optimisation at each level is what produces the global stall.

3. Predictive computational model

   Track ready-for-transfer patients as a queue against the downstream unit rather than as occupants of the upstream one. Queue length at each level exposes where the chain is actually blocked. Queue length is already derivable from the transfer requests each unit receives.

4. Workflow integration

   Show the downstream queue on the step-down unit’s own board. The team that can act on it currently has no view of the demand accumulating against them. A team cannot prioritise demand it has no view of.

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