SimLean EducateInterlude 2: Prioritising patients

An example of a generalised simulation of a theatre

process

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The generalised Day Case theatre process

Run the model »

2 batch

Day 1 Day 2Day 3

Day 4 Day 5

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Patient flow: 2 Batch

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Patient profiles: 2 Batch

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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

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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

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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…..?

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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)