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SimLean EducateInterlude 2: Prioritising patients
An example of a generalised simulation of a theatre
process
2
The generalised Day Case theatre process
Run the model »
2 batch
Day 1 Day 2Day 3
Day 4 Day 5
4
Patient flow: 2 Batch
5
Patient profiles: 2 Batch
6
Holding - 32 minutes
Discharge - 46 minutes
Average Queue Times
Reception -14 minutes
Patient queueing times: 2 Batch
Priority??
Let’s look at what happens when some patients are given priority over others.
In the model:• Patients with white or yellow shirts go to the front
of any queue• Patients with green shirts go to the back• Patient arrival pattern patterns remain
unchanged (2 Batch)
7Run model a » Run model b »
Prioritise a
Prioritise b
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• The number of patients on the premises is sometimes over 25 (compared to 24 under 2 batch)
• More morning patients remain in the system at 1pm (more stress on staff and patient)
• Takes longer for all patients to leave
2 Batch
Prioritise
Impact on Patient flow
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Prioritise2 Batch
In treatment 79 mins 80 mins
Waiting 77 mins 107 mins
Blocked 34 mins 55 mins
Visit times 190 mins 242 mins
Averages
2 Batch PrioritiseReduced patient value
Comparison of Patient profiles
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Prioritised Patients (Pale Shirts) Non-Prioritised Patients (Dark Shirts)
In treatment 79 mins 80mins 79 mins
Waiting 6 mins 159 mins 77 mins
Blocked 71 mins 47 mins 34 mins
Total Visit time 156 mins 286 mins 190 mins
Average times Priority Non-Priority 2 Batch
Comparison of Patient profiles
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13.3% booking inFor both 2 Batch and Prioritise
Unchanged patient
value
Averages
2 Batch14 mins
Prioritise14 mins
Queue for Reception
14
Reduced patient
value for some
Averages
Dark (Non-prioritised)19.5 mins
Pale (Prioritised)
4 mins
Overall14 mins
Queue for Reception
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2 Batch Prioritise42% other 32%38% blocked 48%20% work 20%
Averages
2 Batch32 mins
Prioritise49 mins
Queue for Prepare and Hold
16
Reduced patient
value for some
Averages
Dark ( Non-prioritised)73 mins
Pale (prioritised)2 mins
Overall49 mins
Queue for Prepare and Hold
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Averages
2 Batch46 mins
Prioritise (Dark)65 mins
Queue for Discharge Process
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2 Batch Prioritise35% other 26%5% blocked 14%60% work 60%
2 Batch Prioritise68% other 58%17% blocked 27%15% work 15%
Patient flow through Theatre and Recovery
Summary
• We have illustrated the impact of prioritising patients upon patient flow. We have seen that:– Patient queuing times have increased– Number of patients on the premises has increased– Treatments have been delayed because of increased
blocking.
Is the principle of ‘prioritising’ something you use too much?
If so, how could you use it wisely…..?
19
Interlude insight
If you are going to prioritise, make sure you have sufficient resources to avoid the
blocking and therefore reduce the burden on the ‘non-prioritised’ patients
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THE SLIDES THAT FOLLOW ARE FOR FURTHER INSIGHT
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Patient flow (numbers)2 Batch Prioritise
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Does Prioritise cause later finish times?
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Day 1 Day 2
2 Batch - Time View
Theatre finish time on Day 2
Key: Working
Waiting
Starved
Blocked
Does Prioritise cause later finish times?
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2 Batch - Time View
Prioritise - Time View
Theatre Finish Times (2 Batch)
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