Operational strategies to manage non-elective orthopaedic surgical flows: a simulation modelling study

Abstract

ObjectivesTo explore the value of simulation modelling in evaluating the effects of strategies to plan and schedule operating room (OR) resources aimed at reducing time to surgery for non-elective orthopaedic inpatients at a Swedish hospital.MethodsWe applied discrete-event simulation modelling. The model was populated with real world data from a university hospital with a strong focus on reducing waiting time to surgery for patients with hip fracture. The system modelled concerned two patient groups that share the same OR resources: hip-fracture and other non-elective orthopaedic patients in need of surgical treatment. We simulated three scenarios based on the literature and interaction with staff and managers: (1) baseline; (2) reduced turnover time between surgeries by 20 min and (3) one extra OR during the day, Monday to Friday. The outcome variables were waiting time to surgery and the percentage of patients who waited longer than 24 hours for surgery.ResultsThe mean waiting time in hours was significantly reduced from 16.2 hours in scenario 1 (baseline) to 13.3 hours in scenario 2 and 13.6 hours in scenario 3 for hip-fracture surgery and from 26.0 hours in baseline to 18.9 hours in scenario 2 and 18.5 hours in scenario 3 for other non-elective patients. The percentage of patients who were treated within 24 hours significantly increased from 86.4% (baseline) to 96.1% (scenario 2) and 95.1% (scenario 3) for hip-fracture patients and from 60.2% (baseline) to 79.8% (scenario 2) and 79.8% (scenario 3) for patients with other non-elective patients.ConclusionsHealthcare managers who strive to improve the timelines of non-elective orthopaedic surgeries may benefit from using simulation modelling to analyse different strategies to support their decisions. In this specific case, the simulation results showed that the reduction of surgery turnover times could yield the same results as an extra OR.

A discrete‐event simulation model for assessing operating room efficiency of thoracic, gastrointestinal, and orthopedic surgeries

“…Previous studies have utilized DES to determine the best strategy for optimizing specific areas needing improvement, such as different combinations of surgery prioritization during scheduling. 3,[18][19][20][21][22][23] Our study takes a step back to focus on an earlier planning stage, to find which areas of the OR workflow have the most potential to enhance throughput. Identifying these key areas lays the groundwork for developing and refining strategies tailored to these areas, enabling informed decisions on resource allocation and prioritization.…”

“…Our research brings a new perspective to OR workflows using DES. Previous studies have utilized DES to determine the best strategy for optimizing specific areas needing improvement, such as different combinations of surgery prioritization during scheduling 3,18–23 . Our study takes a step back to focus on an earlier planning stage, to find which areas of the OR workflow have the most potential to enhance throughput.…”

“…By varying one step in the workflow at a time while keeping others constant in different scenarios, we can analyze how enhancements to individual steps influence throughput. While prior studies have employed DES to evaluate specific strategies in areas recognized as needing improvement, such as resource allocation and surgery scheduling, 3,[18][19][20][21][22][23] our research takes a different approach. We aimed to assist the OR nursing department in pinpointing which areas to work on by identifying steps that hold significant potential for impactful improvements on overall throughput.…”

Development and application of simulation modelling for orthopaedic elective resource planning in England

“…DES allows processes and pathways to be modelled at the individual patient level, and to explore the potential impact of changes to the system without the costs and risks associated with real-world changes. It has been used for patient flow management, resource allocation and scheduling, for example, in sexual health,15 stroke pathways16 and orthopaedics 17 18. The DES was developed to have the flexibility to answer a range of ‘what-if’ questions of interest to NBT, and is generalisable to other NHS Trusts for orthopaedic elective planning.…”

A Simulation-Based Approach for Assessing the Impact of Uncertainty on Patient Waiting Time in the Operating Room

“…Schoenfelder et al (2021) use simulation to assess the impact of different management policies related to the patient pathway, emergency handling and staffing level. Persson et al (2017) study the relevance of DES use when evaluating OR scheduling strategies such as reducing turnover time and adding an extra OR. Allen et al (2014) propose a DES approach to study when and how frequently OR schedule display should be updated to obtain both schedule accuracy and staff satisfaction.…”