Raymer M1, Moretto N2,3, Comans T3, O'Leary S3,4, Chang A2, Standfield L5, Carter H6, Osborne S6
1Metro North Hospital and Health Service, Physiotherapy RBWH, Brisbane, Australia, 2Metro North Hospital and Health Service, Brisbane, Australia, 3University of Queensland, Brisbane, Australia, 4Metro North Hospital and Health Service, Physiotherapy, Brisbane, Australia, 5Griffith University, Brisbane, Australia, 6Queensland University Technology, AusHSI, Brisbane, Australia
Background: Musculoskeletal conditions, the second largest cause of disability worldwide, are projected to rise, placing further pressures on overburdened Orthopaedic and Neurosurgery specialist outpatient services. The majority of patients with non-urgent conditions do not require surgical intervention and can be managed through well-coordinated, Advanced Musculoskeletal Physiotherapist (AMP)-led care. In Queensland, Australia, AMP led services have been widely implemented and shown to be highly cost effective. What remains unclear is the optimal scale and professional mix of services required to manage current and projected future service demand.
Simulation modelling techniques have been widely used in operations research and systems design, and can provide valuable support for projecting resource requirements and optimising flow in health services. Discrete event simulation has been applied to explore the most efficient and cost-effective professional mix of services to address demand and meet key access targets in orthopaedic and neurosurgery services.
Purpose: In this study we aimed to undertake and evaluate the implementation of simulation modelling into service planning in Orthopaedic and Neurosurgery services. Specifically, we used simulation modelling to examine the most efficient combination of AMP and surgeon led care to meet key access targets, and evaluated the adoption of modelling recommendations into proposals to change the scale and professional mix of services delivered.
Methods: We constructed five discrete event models to simulate Orthopaedic and Neurosurgery outpatient services at three health services in Queensland. Extensive engagement and consultation with key health service stakeholders occurred and we undertook a prospective, qualitative study exploring stakeholder perspectives about the role of modelling in service planning.
Results: If demand growth continues and service capacity remains unchanged over five years, modelling predicted waiting lists for Orthopaedic and Neurosurgery outpatient services in the 3 health services studied would grow by up to 374%, resulting in 74-100% of semi-urgent and non-urgent patients breaching target wait times. Referral audits indicated 51 to 80% of all new referrals would be suitable to be managed in AMP led services. Simulation modelling identified that expanding the overall scale of services would be required to manage current and predicted future demand if referral growth occurs as predicted, and that altering the professional mix to increase the proportion of patients directed to AMP led services was recommended to most efficiently achieve wait time targets in the medium term. Four out of five (80%) participating services incorporated simulation modelling results into proposals to change the scale and professional mix of services delivered. Key stakeholders reported that the modelling results provided greater confidence and the ability to take a longer-term view of service planning.
Conclusion(s): In Orthopaedic and Neurosurgery Specialist Outpatients, advanced musculoskeletal physiotherapist led services can make a larger contribution to managing demand than currently occurs in Queensland health services and maximising their contribution should be a key part of health service strategies to efficiently meet access targets.
Implications: Simulation modelling can transform existing hospital data into evidence for the most efficient combination of health professional resources. It provides decision makers with greater confidence in allocating funding for business cases that are submitted for consideration.
Keywords: Advanced Physiotherapy practice, Service planning, Musculoskeletal
Funding acknowledgements: This study was funded by the Australian Centre for Health Service Innovation (AusHSI).
Simulation modelling techniques have been widely used in operations research and systems design, and can provide valuable support for projecting resource requirements and optimising flow in health services. Discrete event simulation has been applied to explore the most efficient and cost-effective professional mix of services to address demand and meet key access targets in orthopaedic and neurosurgery services.
Purpose: In this study we aimed to undertake and evaluate the implementation of simulation modelling into service planning in Orthopaedic and Neurosurgery services. Specifically, we used simulation modelling to examine the most efficient combination of AMP and surgeon led care to meet key access targets, and evaluated the adoption of modelling recommendations into proposals to change the scale and professional mix of services delivered.
Methods: We constructed five discrete event models to simulate Orthopaedic and Neurosurgery outpatient services at three health services in Queensland. Extensive engagement and consultation with key health service stakeholders occurred and we undertook a prospective, qualitative study exploring stakeholder perspectives about the role of modelling in service planning.
Results: If demand growth continues and service capacity remains unchanged over five years, modelling predicted waiting lists for Orthopaedic and Neurosurgery outpatient services in the 3 health services studied would grow by up to 374%, resulting in 74-100% of semi-urgent and non-urgent patients breaching target wait times. Referral audits indicated 51 to 80% of all new referrals would be suitable to be managed in AMP led services. Simulation modelling identified that expanding the overall scale of services would be required to manage current and predicted future demand if referral growth occurs as predicted, and that altering the professional mix to increase the proportion of patients directed to AMP led services was recommended to most efficiently achieve wait time targets in the medium term. Four out of five (80%) participating services incorporated simulation modelling results into proposals to change the scale and professional mix of services delivered. Key stakeholders reported that the modelling results provided greater confidence and the ability to take a longer-term view of service planning.
Conclusion(s): In Orthopaedic and Neurosurgery Specialist Outpatients, advanced musculoskeletal physiotherapist led services can make a larger contribution to managing demand than currently occurs in Queensland health services and maximising their contribution should be a key part of health service strategies to efficiently meet access targets.
Implications: Simulation modelling can transform existing hospital data into evidence for the most efficient combination of health professional resources. It provides decision makers with greater confidence in allocating funding for business cases that are submitted for consideration.
Keywords: Advanced Physiotherapy practice, Service planning, Musculoskeletal
Funding acknowledgements: This study was funded by the Australian Centre for Health Service Innovation (AusHSI).
Topic: Service delivery/emerging roles; Musculoskeletal
Ethics approval required: Yes
Institution: Gold Coast Hospital and Health Service
Ethics committee: Gold Coast Hospital and Health Service Human Reserach Ethics Committee
Ethics number: HREC/16/QGC/205
All authors, affiliations and abstracts have been published as submitted.
