University of Hertfordshire Research Archive

        JavaScript is disabled for your browser. Some features of this site may not work without it.

        Browse

        All of UHRABy Issue DateAuthorsTitlesThis CollectionBy Issue DateAuthorsTitles

        Arkivum Files

        My Downloads
        View Item 
        • UHRA Home
        • University of Hertfordshire
        • Research publications
        • View Item
        • UHRA Home
        • University of Hertfordshire
        • Research publications
        • View Item

        A simulation tool for better management of retinal services

        View/Open
        s12913_018_3560_5.pdf (PDF, 601Kb)
        Author
        Demir, Eren
        Southern, David
        Verner, Aimee
        Amoaku, Winfried
        Attention
        2299/20814
        Abstract
        Background: Advances in the management of retinal diseases have been fast-paced as new treatments become available, resulting in increasing numbers of patients receiving treatment in hospital retinal services. These patients require frequent and long-term follow-up and repeated treatments, resulting in increased pressure on clinical workloads. Due to limited clinic capacity, many National Health Service (NHS) clinics are failing to maintain recommended follow-up intervals for patients receiving care. As such, clear and robust, long term retinal service models are required to assess and respond to the needs of local populations, both currently and in the future. Methods: A discrete event simulation (DES) tool was developed to facilitate the improvement of retinal services by identifying efficiencies and cost savings within the pathway of care. For a mid-size hospital in England serving a population of over 500,000, we used 36 months of patient level data in conjunction with statistical forecasting and simulation to predict the impact of making changes within the service. Results: A simulation of increased demand and a potential solution of the 'Treat and Extend' (T&E) regimen which is reported to result in better outcomes, in combination with virtual clinics which improve quality, effectiveness and productivity and thus increase capacity is presented. Without the virtual clinic, where T&E is implemented along with the current service, we notice a sharp increase in the number of follow-ups, number of Anti-VEGF injections, and utilisation of resources. In the case of combining T&E with virtual clinics, there is a negligible (almost 0%) impact on utilisation of resources. Conclusions: Expansion of services to accommodate increasing number of patients seen and treated in retinal services is feasible with service re-organisation. It is inevitable that some form of initial investment is required to implement service expansion through T&E and virtual clinics. However, modelling with DES indicates that such investment is outweighed by cost reductions in the long term as more patients receive optimal treatment and retain vision with better outcomes. The model also shows that the service will experience an average of 10% increase in surplus capacity.
        Publication date
        2018-10-04
        Published in
        BMC Health Services Research
        Published version
        https://doi.org/10.1186/s12913-018-3560-5
        Other links
        http://hdl.handle.net/2299/20814
        Metadata
        Show full item record

        Related items

        Showing items related by title, author, creator and subject.

        • Mapping staff perspectives towards the delivery of hospital care for children and young people with and without learning disabilities in England : A mixed methods national study 

          Oulton, Kate; Gibson, Faith; Carr, Lucinda; Hassiotis, Angela; Jewitt, Carey; Kenten, Charlotte; Russell, Jessica; Whiting, Mark; Tuffrey-Wijne, Irene; Wray, Jo (2018-03-23)
          Background: Children and young people (CYP) with learning disabilities (LD) are a vulnerable population with increased risk of abuse and accidental injury and whose parents have reported concerns about the quality, safety ...
        • The Health and Wellbeing of Female Street Sex Workers 

          Elliott, Nalishebo (2017-11-10)
          Previous research on female street sex workers (FSSWs) has primarily concentrated on the stigmatisation of women’s involvement in the sex industry particularly with reference to the spread of HIV/AIDS. The response of the ...
        • Work of the NHS England Youth Forum and its effect on health services. 

          Whiting, Lisa; Roberts, Sheila; Petty, Julia; Meager, Gary; Evans, Kath (2018-07-11)
          AIM: To examine the role of members of the NHS England Youth Forum (NHSEYF) and the strategies used to influence health service provision for children and young people. METHOD: An evaluative mixed-methods study was ...
        Keep in touch

        © 2019 University of Hertfordshire

        I want to...

        • Apply for a course
        • Download a Prospectus
        • Find a job at the University
        • Make a complaint
        • Contact the Press Office

        Go to...

        • Accommodation booking
        • Your student record
        • Bayfordbury
        • KASPAR
        • UH Arts

        The small print

        • Terms of use
        • Privacy and cookies
        • Criminal Finances Act 2017
        • Modern Slavery Act 2015
        • Sitemap

        Find/Contact us

        • T: +44 (0)1707 284000
        • E: ask@herts.ac.uk
        • Where to find us
        • Parking
        • hr
        • qaa
        • stonewall
        • AMBA
        • ECU Race Charter
        • disability confident
        • AthenaSwan