Capacity and patient flow planning in post-term pregnancy outpatient clinics: a computer simulation modelling study
Abstract Background The demand for a large Norwegian hospital’s post-term pregnancy outpatient clinic has increased substantially over the last 10 years due to changes in the hospital’s catchment area and to clinical guidelines. Planning the clinic is further complicated due to the high did not attend rates as a result of women giving birth. The aim of this study was to develop a tool that supports clinic management to better understand and improve capacity and patient flow planning.Methods A hybrid agent based discrete event simulation model of the clinic was used to evaluate alternative configurations to gain insight into clinic planning and to support decision making. Clinic configurations consisted of six factors: X0: Arrivals. X1: Arrival pattern. X2: Order of midwife and doctor consultations. X3: Number of midwives. X4: Number of doctors. X5: Number of cardiotocography (CTGs) machines. A full factorial experimental design of the six factors generated 608 configurations.Results Each configuration was evaluated using the following measures: Y1: Arrivals. Y2: Time last woman checks out. Y3: Women’s length of stay (LoS). Y4: Clinic overrun time. Y5: Midwife waiting time (WT). Y6: Doctor WT. Y7: CTG connection WT. Optimisation was used to maximise X0 with respect to the 32 combinations of X1-X5. Configuration 0a, the base case Y1 = 7 women and Y3 = 102.97 [0.21] mins. Changing the arrival pattern (X1) and the order of the midwife and doctor consultations (X2) configuration 0d, where X3, X4, X5 = 0a, Y1 = 8 woman and Y3 86.06 [0.10] mins.Conclusions From the clinic’s perspective, the changes in catchment area and clinical guidelines led to increased demand. The simulation model demonstrated flexible pathways in the order of midwife/doctor and appointment scheduling increases flow substantially, reducing LoS. Equipment appeared more of a bottleneck than personnel, as one additional CTG machine has the same effect as an extra midwife and an extra doctor, and the WT for CTG connection is a key contributor to LoS. A more general finding is that a simulation model can be used to identify bottlenecks, and efficient ways of restructuring an outpatient clinic.
