The development and practical application of a simulation model to inform musculoskeletal service delivery in an Australian public health service

Abstract

Timely access to orthopaedic and neurosurgery services in public hospitals is difficult to achieve due to constrained resources and rising demand with the result that waiting time targets are often not met. Advanced physiotherapy-led clinics can assist in managing demand by directly assessing and managing many patients without the need for consultation with a medical specialist. The purpose of this study was to develop and apply simulation modelling to determine the scale and mix of services required to efficiently manage demand from patients with musculoskeletal conditions in one health district. DesignWe designed a simulation model to estimate service demand over five years and test different service configurations (medical specialist-led or advanced physiotherapy-led) to meet waiting time targets and reduce waiting lists in orthopaedic and neurosurgery services. ResultsWithout intervention, the combined orthopaedic and neurosurgical outpatient waiting list is predicted to grow from 11,000 to over 15,000 patients over a five year period. To achieve waiting time targets within 2 years the scale of services would need to approximately double and the most efficient combination would be to direct approximately 50% of referrals to medical specialist clinics and 50% to advanced physiotherapy-led clinics. ConclusionsIn the health system modelled, a significant gap was identified between future demand and current provision of services. Simulation modelling was able to assist service planners understand the demand and identify effective management strategies.