Date of Graduation

Spring 5-18-2023

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Executive Leader DNP

First Advisor

Dr. Mary Bittner

Second Advisor

Dr. Nicholas Webb


Background: The need for inpatient pediatric psychiatric services to address the growing issue of pediatric mental health in a multi-state integrated hospital enterprise is straining the system’s capacity to provide timely mental health care.

Local Problem: Lack of access to specialty pediatric psychiatric treatment for dual diagnosis medi-psychiatric care management is a patient quality and safety issue. Insufficient capacity contributes to longer emergency room boarding times and inpatient length of stay for patients who have a mental illness.

Methods: Use of digital simulation methodology to analyze the behavior of a dynamic event-driven care delivery workflow and to optimize quality patient outcomes by implementing a hub and spoke model of care.

Interventions: A discrete event simulation model was built using retrospective data to evaluate existing resources and “what if” scenarios based on patient movement through a hub-and-spoke regional patient transfer structure.

Results: Simulation of the patient flow determined that a decentralized hub-and-spoke model for management of pediatric dual diagnosis patient volume was unnecessary. Simulation modeling results revealed an average daily census of five indicating an ability to centralize all pediatric dual diagnosis volume into one hub hospital instead of three.

Conclusions: Simulation was a cost effective, predictive, and innovative approach to evaluating alternative care models at the nurse executive level. The project demonstrated that prudent strategy for use of capital project resources can be enhanced at the beginning of the design phase in project management and clarity of scope realized at the macro, meso, and micro levels every project, every time.

Included in

Nursing Commons