Abstract
Very few discrete-event simulation studies follow up on recommendations with evaluation of whether modelled benefits have been realised and the extent to which modelling contributed to any change. This paper evaluates changes made to the emergency stroke care pathway at a UK hospital informed by a simulation modelling study. The aims of the study were to increase the proportion of people with strokes that undergo a time-sensitive treatment to breakdown a blood clot within the brain and decrease the time to treatment. Evaluation involved analysis of stroke treatment pre- and post-implementation, as well as a comparison of how the research team believed the intervention would aid implementation compared to what actually happened. Two years after the care pathway was changed, treatment rates had increased in line with expectations and the hospital was treating four times as many patients than before the intervention in half the time. There is evidence that the modelling process aided implementation, but not always in line with expectations of the research team. Despite user involvement throughout the study it proved difficult to involve a representative group of clinical stakeholders in conceptual modelling and this affected model credibility. The research team also found batch experimentation more useful than visual interactive simulation to structure debate and decision making. In particular, simple charts of results focused debates on the clinical effectiveness of drugs — an emergent barrier to change. Visual interactive simulation proved more useful for engaging different hospitals and initiating new projects.
Highlights
This paper describes the implementation and evaluation of changes to an emergency stroke care pathway in a large acute hospital within the United Kingdom
Most published case studies of discrete-event simulation (DES) in health do not provide any discussion of the implementation of study results [5] or any structured evaluation
In order to provide an evidence base of the impact of simulation modelling in practical applications it is essential to publish accounts of implementation
Summary
These changes followed a discrete-event simulation (DES) study that was undertaken to both identify improvement opportunities and support the implementation of improvement between the clinical stakeholders in the pathway. The DES literature contains many case studies of computer models that compare alternative policies to identify costs and efficiency savings within industry [2] and healthcare [3]. While these case studies are numerous the evidence that such modelling leads to the implementation of simulation results is lacking. When treatment is given within 6 h of onset, the accumulated evidence shows that the benefit of stroke thrombolysis in reducing disability outweighs the risk of intracranial haemorrhage [16,18]
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