SimLean Educate Interlude 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 1Day 2 Day 3 Day 4Day 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) 7 Run model a »Run model b »

Prioritise a

Prioritise b

10 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

11 Prioritise2 Batch In treatment79 mins80 mins Waiting77 mins107 mins Blocked34 mins55 mins Visit times190 mins242 mins Averages 2 BatchPrioritise Reduced patient value Comparison of Patient profiles

12 Prioritised Patients (Pale Shirts)Non-Prioritised Patients (Dark Shirts) In treatment79 mins80mins79 mins Waiting 6 mins159 mins 77 mins Blocked71 mins47 mins34 mins Total Visit time156 mins286 mins190 mins Average timesPriorityNon-Priority2 Batch Comparison of Patient profiles

% booking in For both 2 Batch and Prioritise Unchanged patient value Averages 2 Batch 14 mins Prioritise 14 mins Queue for Reception

14 Reduced patient value for some Averages Dark (Non- prioritised) 19.5 mins Pale (Prioritised) 4 mins Overall 14 mins Queue for Reception

15 2 Batch Prioritise 42% other 32% 38% blocked48% 20% work20% Averages 2 Batch 32 mins Prioritise 49 mins Queue for Prepare and Hold

16 Reduced patient value for some Averages Dark ( Non-prioritised) 73 mins Pale (prioritised) 2 mins Overall 49 mins Queue for Prepare and Hold

17 Averages 2 Batch 46 mins Prioritise (Dark) 65 mins Queue for Discharge Process

18 2 Batch Prioritise 35% other 26% 5% blocked14% 60% work60% 2 Batch Prioritise 68% other 58% 17% blocked27% 15% work15% 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 20

THE SLIDES THAT FOLLOW ARE FOR FURTHER INSIGHT 21

Patient flow (numbers) 2 BatchPrioritise 22

Does Prioritise cause later finish times? 23 Day 1Day 2 2 Batch - Time View Theatre finish time on Day 2 Key:Working Waiting Starved Blocked

Does Prioritise cause later finish times? 24 2 Batch - Time View Prioritise - Time View  Theatre Finish Times (2 Batch) 