Modelling the critical care pathway for cardiothoracic surgery

Nicolas Bahou, Claire Fenwick, Gillian Hopkins Anderson, Robert Van Der Meer, Tony Vassalos

Research output: Contribution to conferenceAbstract

9 Downloads (Pure)

Abstract

The west of Scotland heart and lung centre based at the Golden Jubilee National Hospital houses three national services (heart transplantation, pulmonary hypertension and adult congenital) and all adult cardiothoracic surgery for the region. Recent fluctuations in emergency referrals resulted in increasing waiting times and patient cancellations leading to a desire by senior staff at the centre to review this valued service. The main issue was limited resources, which was aggravated by the stochastic nature of the length of stay (LOS) and arrival of patients. Discrete event simulation (Simul8) was used to assess if an optimized schedule was sufficient, or more radical changes, such as capacity or other resource reallocations should be considered in order to solve the problem. Patients were divided into six different types depending on their condition and LOS at the different stages of the process. The simulation model portrayed each patient type’s pathway with sufficient detail. Patient LOS figures were analyzed and distributions were formed from data stored in Excel files, which were then fitted to the simulation. The model proved successful as it showed figures that were close to what is observed in real life, including average patient LOS in different stages, the maximum and minimum LOS in the system, and most importantly, near-exact cancellation numbers. Acquiring results and knowing exactly when and what caused a cancellation was another strong point of the model. The results showed that the bottleneck was High Dependency Unit (HDU) beds, which were recovery beds used by most patients. Optimizing the schedule relied on leveling out the daily arrival of patients to HDUs, which caused cancellations to be reduced by 20%. However, coupling this technique with minor capacity reallocations caused cancellations to be reduced by up to 60%, and cancellations were completely eliminated for some patient types.
Original languageEnglish
Number of pages1
Publication statusPublished - 23 Mar 2016
Event8th Institute of Mathematics & its Applications International Conference on Quantitative Modelling in the Management of Health and Social Care - Asia House, London, United Kingdom
Duration: 21 Mar 201623 Mar 2016
https://ima.org.uk/1348/8th-ima-conference-quantitative-modelling-management-health-social-care/

Conference

Conference8th Institute of Mathematics & its Applications International Conference on Quantitative Modelling in the Management of Health and Social Care
CountryUnited Kingdom
CityLondon
Period21/03/1623/03/16
Internet address

Fingerprint

Critical Pathways
Critical Care
Cancellation
Surgery
Pathway
Modeling
Length of Stay
Discrete event simulation
Heart Transplantation
Figure
Schedule
Pulmonary Hypertension
Sufficient
Recovery
Resources
Excel
Appointments and Schedules
Discrete Event Simulation
Lung
Waiting Time

Keywords

  • discrete event simulation
  • critical care
  • cardiothoracic surgery
  • Golden Jubilee National Hospital
  • Scotland
  • theatre scheduling

Cite this

Bahou, N., Fenwick, C., Anderson, G. H., Van Der Meer, R., & Vassalos, T. (2016). Modelling the critical care pathway for cardiothoracic surgery. Abstract from 8th Institute of Mathematics & its Applications International Conference on Quantitative Modelling in the Management of Health and Social Care, London, United Kingdom.
Bahou, Nicolas ; Fenwick, Claire ; Anderson, Gillian Hopkins ; Van Der Meer, Robert ; Vassalos, Tony. / Modelling the critical care pathway for cardiothoracic surgery. Abstract from 8th Institute of Mathematics & its Applications International Conference on Quantitative Modelling in the Management of Health and Social Care, London, United Kingdom.1 p.
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Bahou, N, Fenwick, C, Anderson, GH, Van Der Meer, R & Vassalos, T 2016, 'Modelling the critical care pathway for cardiothoracic surgery' 8th Institute of Mathematics & its Applications International Conference on Quantitative Modelling in the Management of Health and Social Care, London, United Kingdom, 21/03/16 - 23/03/16, .

Modelling the critical care pathway for cardiothoracic surgery. / Bahou, Nicolas; Fenwick, Claire; Anderson, Gillian Hopkins; Van Der Meer, Robert; Vassalos, Tony.

2016. Abstract from 8th Institute of Mathematics & its Applications International Conference on Quantitative Modelling in the Management of Health and Social Care, London, United Kingdom.

Research output: Contribution to conferenceAbstract

TY - CONF

T1 - Modelling the critical care pathway for cardiothoracic surgery

AU - Bahou, Nicolas

AU - Fenwick, Claire

AU - Anderson, Gillian Hopkins

AU - Van Der Meer, Robert

AU - Vassalos, Tony

PY - 2016/3/23

Y1 - 2016/3/23

N2 - The west of Scotland heart and lung centre based at the Golden Jubilee National Hospital houses three national services (heart transplantation, pulmonary hypertension and adult congenital) and all adult cardiothoracic surgery for the region. Recent fluctuations in emergency referrals resulted in increasing waiting times and patient cancellations leading to a desire by senior staff at the centre to review this valued service. The main issue was limited resources, which was aggravated by the stochastic nature of the length of stay (LOS) and arrival of patients. Discrete event simulation (Simul8) was used to assess if an optimized schedule was sufficient, or more radical changes, such as capacity or other resource reallocations should be considered in order to solve the problem. Patients were divided into six different types depending on their condition and LOS at the different stages of the process. The simulation model portrayed each patient type’s pathway with sufficient detail. Patient LOS figures were analyzed and distributions were formed from data stored in Excel files, which were then fitted to the simulation. The model proved successful as it showed figures that were close to what is observed in real life, including average patient LOS in different stages, the maximum and minimum LOS in the system, and most importantly, near-exact cancellation numbers. Acquiring results and knowing exactly when and what caused a cancellation was another strong point of the model. The results showed that the bottleneck was High Dependency Unit (HDU) beds, which were recovery beds used by most patients. Optimizing the schedule relied on leveling out the daily arrival of patients to HDUs, which caused cancellations to be reduced by 20%. However, coupling this technique with minor capacity reallocations caused cancellations to be reduced by up to 60%, and cancellations were completely eliminated for some patient types.

AB - The west of Scotland heart and lung centre based at the Golden Jubilee National Hospital houses three national services (heart transplantation, pulmonary hypertension and adult congenital) and all adult cardiothoracic surgery for the region. Recent fluctuations in emergency referrals resulted in increasing waiting times and patient cancellations leading to a desire by senior staff at the centre to review this valued service. The main issue was limited resources, which was aggravated by the stochastic nature of the length of stay (LOS) and arrival of patients. Discrete event simulation (Simul8) was used to assess if an optimized schedule was sufficient, or more radical changes, such as capacity or other resource reallocations should be considered in order to solve the problem. Patients were divided into six different types depending on their condition and LOS at the different stages of the process. The simulation model portrayed each patient type’s pathway with sufficient detail. Patient LOS figures were analyzed and distributions were formed from data stored in Excel files, which were then fitted to the simulation. The model proved successful as it showed figures that were close to what is observed in real life, including average patient LOS in different stages, the maximum and minimum LOS in the system, and most importantly, near-exact cancellation numbers. Acquiring results and knowing exactly when and what caused a cancellation was another strong point of the model. The results showed that the bottleneck was High Dependency Unit (HDU) beds, which were recovery beds used by most patients. Optimizing the schedule relied on leveling out the daily arrival of patients to HDUs, which caused cancellations to be reduced by 20%. However, coupling this technique with minor capacity reallocations caused cancellations to be reduced by up to 60%, and cancellations were completely eliminated for some patient types.

KW - discrete event simulation

KW - critical care

KW - cardiothoracic surgery

KW - Golden Jubilee National Hospital

KW - Scotland

KW - theatre scheduling

UR - https://ima.org.uk/1348/8th-ima-conference-quantitative-modelling-management-health-social-care/

UR - https://pure.strath.ac.uk/admin/files/72169424/Programme_IMA_Health_and_Social_2016.pdf

M3 - Abstract

ER -

Bahou N, Fenwick C, Anderson GH, Van Der Meer R, Vassalos T. Modelling the critical care pathway for cardiothoracic surgery. 2016. Abstract from 8th Institute of Mathematics & its Applications International Conference on Quantitative Modelling in the Management of Health and Social Care, London, United Kingdom.