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

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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

Keywords

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

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  • Research Output

    Modelling the critical care pathway for cardiothoracic surgery

    Bahou, N., Fenwick, C., Anderson, G., van der Meer, R. & Vassalos, T., 16 May 2017, In : Healthcare Management Science. p. 1-12 17 p.

    Research output: Contribution to journalArticle

    Open Access
    File
  • 2 Citations (Scopus)
    69 Downloads (Pure)

    Activities

    • 1 Invited talk

    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

    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.