Development and application of simulation modelling for orthopaedic elective resource planning in England

Authors
Affiliations

Alison Harper

University of Exeter Medical School

Thomas Monks

University of Exeter Medical School

Rebecca Wilson

NIHR Applied Research Collaboration West, Bristol

Maria Theresa Redaniel

NIHR Applied Research Collaboration West, Bristol

Emily Eyles

NIHR Applied Research Collaboration West, Bristol

Tim Jones

NIHR Applied Research Collaboration West, Bristol

Chris Penfold

NIHR Bristol Biomedical Research Centre, Bristol

Andrew Elliott

North Bristol NHS Trust Southmead Hospital, Bristol

Tim Keen

North Bristol NHS Trust Southmead Hospital, Bristol

Martin Pitt

University of Exeter Medical School

Ashley Blom

University of Sheffield

Michael R Whitehouse

North Bristol NHS Trust Southmead Hospital, Bristol

Andrew Judge

NIHR Bristol Biomedical Research Centre, Bristol

Published

22 Dec 2023

Doi

10.1136/bmjopen-2023-076221

Abstract

Objectives This study aimed to develop a simulation model to support orthopaedic elective capacity planning.

Methods An open-source, generalisable discrete-event simulation was developed, including a web-based application. The model used anonymised patient records between 2016 and 2019 of elective orthopaedic procedures from a National Health Service (NHS) Trust in England. In this paper, it is used to investigate scenarios including resourcing (beds and theatres) and productivity (lengths of stay, delayed discharges and theatre activity) to support planning for meeting new NHS targets aimed at reducing elective orthopaedic surgical backlogs in a proposed ring-fenced orthopaedic surgical facility. The simulation is interactive and intended for use by health service planners and clinicians.

Results A higher number of beds (65–70) than the proposed number (40 beds) will be required if lengths of stay and delayed discharge rates remain unchanged. Reducing lengths of stay in line with national benchmarks reduces bed utilisation to an estimated 60%, allowing for additional theatre activity such as weekend working. Further, reducing the proportion of patients with a delayed discharge by 75% reduces bed utilisation to below 40%, even with weekend working. A range of other scenarios can also be investigated directly by NHS planners using the interactive web app.

Conclusions The simulation model is intended to support capacity planning of orthopaedic elective services by identifying a balance of capacity across theatres and beds and predicting the impact of productivity measures on capacity requirements. It is applicable beyond the study site and can be adapted for other specialties.

Article

Citation

BibTeX citation:
@online{harper2023,
  author = {Harper, Alison and Monks, Thomas and Wilson, Rebecca and
    Theresa Redaniel, Maria and Eyles, Emily and Jones, Tim and Penfold,
    Chris and Elliott, Andrew and Keen, Tim and Pitt, Martin and Blom,
    Ashley and R Whitehouse, Michael and Judge, Andrew},
  title = {Development and Application of Simulation Modelling for
    Orthopaedic Elective Resource Planning in {England}},
  date = {2023-12-22},
  url = {https://pythonhealthdatascience.github.io/stars/pages/publications/2023/harper2023development/},
  doi = {10.1136/bmjopen-2023-076221},
  langid = {en}
}
For attribution, please cite this work as:
Harper, Alison, Thomas Monks, Rebecca Wilson, Maria Theresa Redaniel, Emily Eyles, Tim Jones, Chris Penfold, et al. 2023. “Development and Application of Simulation Modelling for Orthopaedic Elective Resource Planning in England.” December 22, 2023. https://doi.org/10.1136/bmjopen-2023-076221.