Patient pathway modelling using discrete event simulation to improve the management of COPD

Abstract

The number of people affected by chronic obstructive pulmonary disease (COPD) is increasing and the hospital readmission rate is remarkably high. Therefore, healthcare professionals and managers have financial and workforce-related pressures. A decision support toolkit (DST) for improving the management and efficiency of COPD care is needed to respond to the needs of patients now and in the future. In collaboration with the COPD team of a hospital and community service in London, we conceptualised the pathway for COPD patients and developed a discrete event simulation model (DES) incorporating the dynamics of patient readmissions. A DES model or operational model at this scale has never been previously developed, despite many studies using other modelling and simulation techniques in COPD. Our model is the first of its kind to include COPD readmissions as well as assessing the quantifiable impact of re-designing COPD services. We demonstrate the impact of post-exacerbation pulmonary rehabilitation (PEPR) policy and observe that PEPR would be cost-effective with improvements in quality-adjusted life years (QALYs), reduction in emergency readmissions and occupied bed days. The DST improves the understanding of the impact of scenarios (activities, resources, financial implications etc.) for key decision makers and supports commissioners in implementing the interventions.

Keywords:

• Patient flow modelling
• discrete event simulation
• COPD
• readmission
• decision support toolkit

Acknowledgements

We would like to thank the following healthcare professionals for allocating their precious time and valuable input to build the COPD pathway: Dr Swapna Mandal, Stephen Byrd, Ailsa Carmichael, Anthony Geraets, Lisa Wordsworth, Abigail Greenwell (all Royal Free London NHS Foundation Trust); Travis Edwards, Bianca Nwaneri (all Central and North West London NHS Foundation Trust). Usame Yakutcan is thankful to the Hertfordshire Business School for making this study possible by waiving his tuition fees for this PhD study.

Disclosure statement

No potential conflict of interest was reported by the author(s).