Simulating neonatal intensive care capacity in British Columbia

Each year, a small number of expectant mothers with high-risk pregnancies in British Columbia (BC) are sent to the United States (US) because of a lack of neonatal intensive care unit (NICU) beds. We developed a discrete-event simulation model to determine the impact of changing the number of NICU beds in BC on the probability of transfer to the US and on overall system costs. The model includes births in 25 different zones at five different levels of care; transitions between levels of care over time; and transfers of patients between zones and to the US when there is insufficient capacity. We parameterized the model using data from the BC Health System, the Canadian Institute for Health Information, published reports, internal hospital data and expert opinion. Our analysis suggests that the province should consider a modest increase in NICU capacity. In particular, the use of a bottleneck approach to identify the type and location of 4 new beds at select hospitals throughout the system resulted in a reduction in the probability of transfer to the US and an increase in annual system costs. A model like the one described in this paper may be useful to evaluate the tradeoffs associated with capacity expansion for a number of different services where Canadians seek care in the US.