Abstract
The west of Scotland heart and lung center based at the Golden Jubilee National Hospital houses all adult cardiothoracic surgery for the region. Increased demand for scheduled patients and fluctuations in emergency referrals resulted in increasing waiting times and patient cancellations. 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 (DES) was used to assess if an enhanced 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 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 historical data, which were then used in the simulation. The model proved successful as it showed figures that were close to actual observations. Acquiring results and knowing exactly when and what caused a cancellation was another strong point of the model. The results demonstrated that the bottleneck in the system was related to the use of High Dependency Unit (HDU) beds, which were the recovery beds used by most patients. Enhancing the schedule by leveling out the daily arrival of patients to HDUs reduced patient cancellations by 20%. However, coupling this technique with minor capacity reallocations resulted in more than 60% drop in cancellations.
Highlights
Golden Jubilee National Hospital (GJNH) is Scotland’s flagship hospital which specialises in heart and lung services [1]
Based on their experience and previous studies performed by GJNH it was determined that capacity was the main issue affecting the schedule and the model would start by patients arriving to theatres without taking the booking system into consideration
Feeding actual hospital length of stay (LOS) data to a simulation model proved effective in measuring the results of applying different scenarios to hospital operations including enhancing the schedule, reallocating capacity and enhancing the recovery of different patients at the different stages of their stay
Summary
Golden Jubilee National Hospital (GJNH) is Scotland’s flagship hospital which specialises in heart and lung services [1]. It serves the population of the whole of the West of Scotland for all adult cardiothoracic services and is the only hospital in Scotland to provide three national services for advanced heart failure, adult congenital cardiac services and the pulmonary vascular unit. It undertakes more than 2600 heart and lung surgeries per year. He proposed that increases in capacity for ICU will be met with increased competition for theatre space, decreasing ICU utilization and diminishing increases in throughput
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