Ensuring patients get the treatment they need as soon as possible is every hospital’s top priority. So when Guy’s and St Thomas’​ NHS Foundation Trust (GSTT) noticed a significant decrease in the amount of Cardiac surgery activity at its hospitals, it wanted to understand why.

Accessing data from the National Institute for Cardiac Outcomes Research (NICOR), which dates back to 2000, the Trust discovered that cardiac surgery activity at GSTT had in fact been falling consistently for the past 20 years. There were 1,415 cardiac surgeries in 2000, which fell to 1,016 in 2015, and reached an all-time low of just 956 in 2018.

These figures represented a 33% decrease in the number of cardiac surgeries since the turn of the millennium. The obvious question was, why?

The falling number of surgeries wasn’t down to one isolated reason. It was likely multifactorial, a combination of varying referral patterns, increased case complexity and a reduction in access to surgical facilities. The common factors, however, were longer patient pathways and operational inefficiencies. 

This resulted in longer wait times for patients and an inability to accept work from new referrals – both undesirable outcomes for GSTT, one of the UK’s busiest and most successful NHS foundation trusts.

Finding a solution

A decision was made to use simulation to gain a greater understanding of how multi-factorial elements can converge to shape the service as a whole. While human teams may be able to consider several outcomes and join up a few dots, simulation offers the capability of doing this at scale, providing invaluable insight to teams that manage – or partake in – complex processes.

Using Simul8 simulation software, the Trust wanted to analyze how changing capacity at various points in the patient pathway would impact activity volumes and wait times for patients. Simul8’s was selected for its ability to handle the complex patient pathways involved, including the data generated by the many discrete events involved in more than 1,000 major cardiac operations.

Building the simulation

The adult surgical pathway is hugely complex, but it can be broken down into discrete events that lend itself well to modelling. Cardiac patients tend to fall into two main categories; elective, which means the admission is planned from home; and in-patient, which is an unplanned admission from any location.

Beyond that, there are hundreds of variable factors, including inter-hospital transfers and direct admissions from A&E. Simul8 had to consider all of these variables, linking them to surgery and recovery beds throughout the Trust.

One of the key markers of efficiency, and a key metric for GSTT, was the length of time patients had to wait for their surgery, either at home or in a hospital bed. Using DES, and with Simul8 playing a key role, the Trust was able to assess what impact changing capacity or prioritization in different areas of the hospital would have on patient waiting lists.

A new way forward

Hospitals are no stranger to gathering data, but until recently GSTT hadn’t analyzed its data beyond the surgery activity itself. Discrete Event Analysis took ostensibly mundane or trivial data, and used it to gain extremely valuable insight that has now pushed GSTT to not only increase its operational efficiency, but re-evaluate the way it looks at data more generally. This data revelation would not have occurred without simulation technology.

Joanna Ward, Deputy General Manager at the Trust, was heavily involved in managing the DES process and provided key clinical oversight. When asked about simulation, she commented: “I think this networked approach to delivering healthcare services is the future of the NHS, and tools like DES will be invaluable in helping us shape that future.”

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