Abstract
BackgroundThe demand for a large Norwegian hospital’s post-term pregnancy outpatient clinic has increased substantially over the last 10 years due to changes in the hospital’s catchment area and to clinical guidelines. Planning the clinic is further complicated due to the high did not attend rates as a result of women giving birth. The aim of this study is to determine the maximum number of women specified clinic configurations, combination of specified clinic resources, can feasibly serve within clinic opening times.MethodsA hybrid agent based discrete event simulation model of the clinic was used to evaluate alternative configurations to gain insight into clinic planning and to support decision making. Clinic configurations consisted of six factors: X0: Arrivals. X1: Arrival pattern. X2: Order of midwife and doctor consultations. X3: Number of midwives. X4: Number of doctors. X5: Number of cardiotocography (CTGs) machines. A full factorial experimental design of the six factors generated 608 configurations.ResultsEach configuration was evaluated using the following measures: Y1: Arrivals. Y2: Time last woman checks out. Y3: Women’s length of stay (LoS). Y4: Clinic overrun time. Y5: Midwife waiting time (WT). Y6: Doctor WT. Y7: CTG connection WT. Optimisation was used to maximise X0 with respect to the 32 combinations of X1-X5. Configuration 0a, the base case Y1 = 7 women and Y3 = 102.97 [0.21] mins. Changing the arrival pattern (X1) and the order of the midwife and doctor consultations (X2) configuration 0d, where X3, X4, X5 = 0a, Y1 = 8 woman and Y3 86.06 [0.10] mins.ConclusionsThe simulation model identified the availability of CTG machines as a bottleneck in the clinic, indicated by the WT for CTG connection effect on LoS. One additional CTG machine improved clinic performance to the same degree as an extra midwife and an extra doctor. The simulation model demonstrated significant reductions to LoS can be achieved without additional resources, by changing the clinic pathway and scheduling of appointments. A more general finding is that a simulation model can be used to identify bottlenecks, and efficient ways of restructuring an outpatient clinic.
Highlights
The demand for a large Norwegian hospital’s post-term pregnancy outpatient clinic has increased substantially over the last 10 years due to changes in the hospital’s catchment area and to clinical guidelines
There is a lack of studies that investigated the operational impact on post-term pregnancy outpatient clinics after the change of guidelines. In this computer simulation study, we developed a model of the post-term pregnancy clinic at Akershus University Hospital (AHUS), to evaluate clinic management strategies
From an AHUS perspective, the changes in catchment area and guidelines for post-term pregnant women led to an increased work load for the clinic
Summary
The demand for a large Norwegian hospital’s post-term pregnancy outpatient clinic has increased substantially over the last 10 years due to changes in the hospital’s catchment area and to clinical guidelines. Context The World Health Organisation (WHO) defines a pregnancy as post-term when the gestation period exceeds 42 (> 294 days) gestational weeks (GW) [1]. From 2008 to 2009 guidelines in the US, UK and in parts of Scandinavia were updated; women with low-risk pregnancies were offered induction of labour between GW 41 and 42 to avoid the risks of prolonged pregnancy [2,3,4]. If induction of labour is contraindicated due to medical reasons, the patient will be offered a caesarean section when appropriate due to the clinical context
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