Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital

Gillian H Anderson, Paul J Jenkins, David A McDonald, Robert Van Der Meer, Alec Morton, Margaret Nugent, Lech A Rymaszewski

Research output: Contribution to journalArticle

9 Citations (Scopus)
47 Downloads (Pure)


Objective: Healthcare faces the continual challenge of improving outcome whilst aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. Design:  Discrete event simulation was used to model and analyse cost and resource utilisation with an activity based costing approach. Data for a full comparison before the process change was unavailable so we utilised a modelling approach, comparing a Virtual Fracture Clinic (VFC) to a simulated Traditional Fracture Clinic (TFC). Setting:  The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. Outcome measures: Our study focused exclusively on non-operative trauma patients attending Emergency Department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries in association with activity costs from the models.ResultsPatients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p=<0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI: 21.74, 23.92) per patient compared with £36.81 (95% CI: 35.65, 37.97) for the TFC pathway.  Conclusions:  Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional face-to-face clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings.
Original languageEnglish
Number of pages12
JournalBMJ Open
Issue number9
Publication statusPublished - 8 Sep 2017


  • orthopaedics
  • patient outcomes
  • costs
  • outpatients
  • fracture clinic

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  • Research Output

    • 9 Citations
    • 1 Abstract
    • 1 Article
    Open Access
  • Micro analysis of orthopaedic outpatient fracture pathway design

    Anderson, G., van der Meer, R. & Morton, A., 2015, p. 264. 1 p.

    Research output: Contribution to conferenceAbstract

  • Activities

    • 2 Participation in workshop, seminar, course
    • 2 Invited talk
    • 1 Participation in conference
    • 1 Membership of network

    Management Science Modelling of Healthcare Systems

    Robert van der Meer (Invited speaker), Gillian Hopkins Anderson (Contributor) & Alison Bradley (Contributor)

    20 Aug 2018

    Activity: Talk or presentation typesInvited talk

    Workshop on Active Clinical Referral Triage (ACRT)

    Gillian Hopkins Anderson (Participant) & Robert van der Meer (Participant)

    6 Aug 2018

    Activity: Participating in or organising an event typesParticipation in workshop, seminar, course

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