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. 2018 Oct 4;18(1):759.
doi: 10.1186/s12913-018-3560-5.

A simulation tool for better management of retinal services

Eren Demir  1   2 , David Southern  3 , Aimee Verner  4 , Winfried Amoaku  5
Affiliations

A simulation tool for better management of retinal services

Eren Demir et al. BMC Health Serv Res. .

Abstract

Background: Advances in the management of retinal diseases have been fast-paced as new treatments become available, resulting in increasing numbers of patients receiving treatment in hospital retinal services. These patients require frequent and long-term follow-up and repeated treatments, resulting in increased pressure on clinical workloads. Due to limited clinic capacity, many National Health Service (NHS) clinics are failing to maintain recommended follow-up intervals for patients receiving care. As such, clear and robust, long term retinal service models are required to assess and respond to the needs of local populations, both currently and in the future.

Methods: A discrete event simulation (DES) tool was developed to facilitate the improvement of retinal services by identifying efficiencies and cost savings within the pathway of care. For a mid-size hospital in England serving a population of over 500,000, we used 36 months of patient level data in conjunction with statistical forecasting and simulation to predict the impact of making changes within the service.

Results: A simulation of increased demand and a potential solution of the 'Treat and Extend' (T&E) regimen which is reported to result in better outcomes, in combination with virtual clinics which improve quality, effectiveness and productivity and thus increase capacity is presented. Without the virtual clinic, where T&E is implemented along with the current service, we notice a sharp increase in the number of follow-ups, number of Anti-VEGF injections, and utilisation of resources. In the case of combining T&E with virtual clinics, there is a negligible (almost 0%) impact on utilisation of resources.

Conclusions: Expansion of services to accommodate increasing number of patients seen and treated in retinal services is feasible with service re-organisation. It is inevitable that some form of initial investment is required to implement service expansion through T&E and virtual clinics. However, modelling with DES indicates that such investment is outweighed by cost reductions in the long term as more patients receive optimal treatment and retain vision with better outcomes. The model also shows that the service will experience an average of 10% increase in surplus capacity.

Keywords: Discrete event simulation; Patient flow modelling; Retinal services; Treat and extend; Virtual clinics.

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Conflict of interest statement

Ethics approval and consent to participate

Ethics approval and participant consent was not necessary as this study involved the use of the national Hospital Episodes Statistics (HES) dataset. Details about HES can be obtained at http://content.digital.nhs.uk/hes. In addition, the data collection for this study did not require ethics approval as: a) derived from secondary sources which are clearly set out in the paper, b) did not include any patient level identifiable data, c) did not include any patient/public participants, d) the study is categorized as a service evaluation using a consultation approach. The consultants, nurses and service managers involved in the research opted to participate. The interviews were not mandatory. Verbal consent was sought from the consultants, nurses and service managers, where participants had given full consent. As stated in Declarations section, UK ethical approval is not a compulsory requirement for studies which do not involve patients (see the following link for details http://www.hra.nhs.uk/documents/2013/09/does-my-project-require-rec-review.pdf).

Consent for publication

Not applicable.

Competing interests

David Southern is an employee of Pathway Communications. No conflicting relationship exists for the other authors regarding this article.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Conceptualised pathway for retinal service patients
See this image and copyright information in PMC

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