Abstract for: Breaking Acute Bed Capacity Bottlenecks: Decision-Support Insights from the MID-CARE Model for Ireland’s Regional Health Area

University Hospital Limerick in Ireland's Mid-West health region experiences chronic overcrowding, characterised by reinforcing feedback loops that exacerbate congestion through prolonged wait times and delayed discharges. Balancing feedback loops, while present, are constrained by limited capacity in regional Model 2 hospitals. The trolley crisis from 2019 to 2023, with 239 recorded deaths (90\% in critical conditions), underscores the need to model dynamic congestion rather than rely on static capacity projections. To address these challenges, this paper presents the Midwest Integrated Demand and Capacity Analysis for Regional Emergency (MID-CARE) care model, a dynamic simulation framework that captures hospital congestion and capacity bottlenecks as emergent behaviours of interconnected feedback loops. The model is informed by demographic, hospital capacity, and workforce trends, and enables testing of policy interventions, including bed capacity expansion and workforce adjustments, to assess long-term systemic impacts. Bseline simulation results indicate sustained population growth and incremental consultant workforce expansion in the Mid-West region, with bed capacity lagging behind demand. University Hospital Limerick remains under significant pressure, while Model 2 hospitals show only modest increases in capacity. These projections highlight persistent structural constraints and reinforce the urgent need for targeted interventions to rebalance resources and prevent worsening overcrowding. The model highlights urgent regional healthcare imbalances, with University Hospital Limerick facing unsustainable overcrowding. Despite gradual consultant growth, bed capacity remains inadequate to meet projected demand. Reinforcing feedback loops show congestion will worsen without intervention. Scenario-based planning and investment in regional hospitals are critical to alleviate UHL pressure. Dynamic workforce and capacity strategies aligned with Sláintecare goals will be essential for long-term system resilience. Support structured editing and literature interrogation.