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Appl Clin Inform 2025; 16(05): 1761-1770
DOI: 10.1055/a-2729-9693
Research Article

Enhancing Efficiency, Reducing Length of Stay and Costs in Pediatric Cardiology Rounds Through Simulation-Based Optimization

Authors

  • Yifan Yang

    1   Department of Integrated Systems Engineering, The Ohio State University, Columbus, Ohio, United States

  • Silvio Fernandes-Junior

    2   IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, United States

  • Thipkanok Wongphothiphan

    2   IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, United States

  • Xu Zhang

    2   IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, United States

  • Jeffrey Hoffman

    3   Division of Clinical Informatics, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States

  • Jessica Bowman

    4   Department of Cardiology, The Heart Center at Nationwide Children's Hospital, Columbus, Ohio, United States

  • Yungui Huang

    2   IT Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, United States

Funding Nationwide Children's Hospital financial support through the internship program.
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Abstract

Background

Enhancing the efficiency of family-centered rounds (FCRs) while ensuring timely patient care has been a focus of study over the past decade. We employed an Operations Research technique (i.e., simulation) to identify opportunities for improving rounding efficiency on our inpatient cardiology unit at Nationwide Children's Hospital (NCH).

Objectives

Through simulation of schedule-based rounds, our aims were to reduce the length of stay (LOS) and subsequent healthcare costs via (1) prioritizing rounds for patients needing time-sensitive care decisions or those likely ready to be discharged, and (2) enhancing participation from both families and bedside nurses during rounds.

Methods

Data were collected through direct observation of rounding activities. We then conducted simulations to evaluate the effect of various rounding paths on efficiency, measured in terms of time and penalties depending on context.

Results

Our simulations indicated a tradeoff between minimizing the risk of delayed rounding and the amount of time spent on rounds. Optimizing rounds for 20 patients reduced cumulative patient waiting time and associated penalty scores. Based on prior research linking earlier clinical interventions to improved efficiency, this approach is estimated to reduce LOS by 166.08 hours and cost by approximately $3,460 per rotation.

Conclusion

By simulating the hospital rounding processes on an inpatient pediatric cardiology unit, we demonstrated that prioritized rounding could reduce both LOS and associated costs. Despite a potential increase in total rounding time, which can be managed by clinical decision-makers, we recommend utilizing scheduling-based FCRs based on prioritization techniques that enhance rounding efficiency while minimizing risk and cost.

Keywords

length of stay - family-centered rounds - healthcare costs - clinical decision support system - simulation and modeling

Authors' Contributions

Y.Y. and S.F.-J.: performed fields observations; all authors listed have contributed to this article as follows:


• Collaborated on study design, collected data, conducted literature review, simulation and analysis, and drafted the manuscript;


• Interpretation of results and manuscript writing;


• Provided critical inputs to study design and interpretation of results.


All the authors reviewed and approved the final version to be published.


Protection of Human and Animal Subjects

This study did not involve human or animal subjects and therefore did not require institutional review board (IRB) approval.


Data Availability

The data underlying this article are available in the article.




Publication History

Received: 28 April 2025

Accepted: 21 October 2025

Article published online:
20 November 2025

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