Micro analysis of orthopaedic outpatient fracture pathway design

The aim of this work was to retrospectively evaluate the redesign of the fracture pathway in a major NHS hospital, focusing on cost effectiveness at a micro level. The processes contain multiple points of variation at the input and at various stages throughout, which were considered in the evaluation. Discrete event simulation was used to model a major part of the redesign, a virtual fracture clinic, and the results compared with a model of a traditional clinic. Resource utilisation and cost was reported for each of the models. An important element of the costing was the family and patient resource or the societal cost of the redesign. This was evaluated using questionnaires to determine the number of clinic visits that patients make and the inconvenience this causes them in terms of time and out-of-pocket expenses. This work shows that there are savings from implementing the fracture redesign process, at least within the test hospital and from the perspective of health board and government funding. If this redesign were to be rolled out further across Scotland it could result in significant effectiveness and efficiency savings. It is envisaged that the simulation model could be further used as a tool to support the process roll-out to other hospitals across Scotland.