Development and application of simulation modelling for orthopaedic elective resource planning in England
Martin Pitt,
Andrew Judge,
Tim Jones,
Michael R Whitehouse,
Thomas Monks,
Rebecca Wilson,
Chris Penfold,
Andrew Elliott,
Ashley Blom,
Maria Theresa Redaniel,
Alison Harper,
Emily Eyles,
Tim Keen
Affiliations
Martin Pitt
Medical School, University of Exeter, Exeter, United Kingdom
Andrew Judge
7 Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
Tim Jones
NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Michael R Whitehouse
Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol Medical School, Bristol, UK
Thomas Monks
2 National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, Hampshire, UK
Rebecca Wilson
The Nightingale Breast Cancer Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
Chris Penfold
2 National Institute for Health Research (NIHR) Biomedical Research Centre (Surgical Innovation Theme), Musculoskeletal Research Unit, University of Bristol, Bristol, UK
Andrew Elliott
2Caris Life Sciences, Phoenix, AZ, USA
Ashley Blom
School of Clinical Sciences, University of Bristol, Bristol, UK
Maria Theresa Redaniel
Applied Research Collaboration West (NIHR ARC West), National Institute for Health Research, Bristol, UK
Alison Harper
Brighton and Hove reporter
Emily Eyles
The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
Tim Keen
North Bristol NHS Trust, Westbury on Trym, Bristol, UK
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.
