A simulation-based decision support tool for informing the management of patients in retinal services

Abstract

Retinal vascular diseases are a leading cause of blindness in the Western world. Advancement in the clinical management of these diseases has been fast-paced, with new treatments becoming available. Eye care services account for nearly one in ten hospital outpatient appointments in England. This paper discusses the development of a decision support toolkit (DST) that facilitates the improvement of retinal services by identifying cost savings and efficiencies within the pathway of care. The paper describes the development of the DST with the help of NHS and commercial experts in the retinal pathway. The DST enables users to model their own services by working with the DST interface allowing them to specify local services. Users can input local estimates or data of service demands and capacities thus creating a baseline discrete event simulation model. Users can then compare the baseline with potential changes in the patient pathway in the safety of a virtual environment. The tool enables key decision makers to estimate the likely impact of changes, such as increased use of new treatment vs. existing treatment regime. By making such changes the impact on activity, cost, staffing levels, skill-mix and utilisation of resources can be easily understood. Such previously unobtainable quantitative information can be used to support business cases for change in retinal services