Looking in the wrong place for healthcare improvements: A system dynamics study of an accident and emergency department
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Looking in the wrong place for healthcare improvements: A system dynamics study of an accident and emergency department DC Lane*, C Monefeldt and JV Rosenhead The London School of Economics and Political Science, University of London Accident and Emergency (A&E) units provide a route for patients requiring urgent admission to acute hospitals. Public concern over long waiting times for admissions motivated this study, whose aim is to explore the factors which contribute to such delays. The paper discusses the formulation and calibration of a system dynamics model of the interaction of demand pattern, A&E resource deployment, other hospital processes and bed numbers; and the outputs of policy analysis runs of the model which vary a number of the key parameters. Two signi®cant ®ndings have policy implications. One is that while some delays to patients are unavoidable, reductions can be achieved by selective augmentation of resources within, and relating to, the A&E unit. The second is that reductions in bed numbers do not increase waiting times for emergency admissions, their effect instead being to increase sharply the number of cancellations of admissions for elective surgery. This suggests that basing A&E policy solely on any single criterion will merely succeed in transferring the effects of a resource de®cit to a different patient group. Keywords: simulation; hospitals; planning; health service; validation; systems; scenarios
Introduction Accident and emergency and the crisis in British health care The National Health Service (NHS) has been in semipermanent crisis during two decades of government restraints on public sector expenditure. Despite the election of a new government in May 1997, problems continue (Independent, 16.8.97, Daily Telegraph, 5.5.99). Among the indicators of crisis have been repeated reorganisations, closure of facilities, over-worked junior doctors, lengthy waiting lists, cancellation of scheduled admissions to hospital, and depletion of budgets before the year end leading to curtailment of activity. In recent years public and political concern has focused in particular on the performance of Accident and Emergency departments at acute hospitals. Accident and Emergency (A&E) provides access to hospital services for urgent cases. The A&E (or casualty) department is used both by individuals brought by ambulance and by those presenting themselves for treatment. The latter, in particular, include people whose medical conditions vary widely in severity. A&E therefore performs a sorting function, deals itself with a range of less seriously ill patients and assesses more serious cases for admission as inpatient. Only 15±20% of patients arriving at A&E require admission to beds on hospital wards.1 *Correspondence: Dr DC Lane, Operational Research Department, London School of Economics and Political Science, Houghton St., London WC2A 2AE, UK. E-mail: [email protected]
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