Contents of Third 2005 Issue

Nosokinetics

Third Issue in 2005

(c)Authors for content; Peter Millard, Roy Johnston for e-version

(comments to rjtechne at iol dot ie)

In this issue we have the following papers and notices. The notices are embedded in this page, and the papers are hotlinked each to their own page. Our thanks to IMS for the e-version. Ed.

Here first are the substantive papers:

Modelling Queues in A&E, Leon K Au

Access Block: Emergency Department Overcrowding, DM Fatovich MBBS FACEM

'Access block' refers to the situation where patients in the Emergency Department (ED) requiring inpatient care are unable to gain access to appropriate hospital beds within a reasonable time frame. We systematically evaluated the relationship between access block, emergency department overcrowding, ambulance diversion and emergency department activity....

Can Patient Choice Degrade Health Systems? Steve Gallivan

If you have often wondered, "Why changes made with good intentions often make a clinical service worse?" Steve Gallivan explains Braess's paradox. Patient choice is now high on political agendas, based on experience with new traffic schemes, Steve explains why patient choice may in the long run be detrimental to patient care. A considerable body of research knowledge is in the field of traffic flow; similar research is needed in health care systems (Ed).

Welfare state to welfare market: Part 2 Here and now and beyond

Dr. Chooi Lee, Consultant Physician, Kingston Hospital, Surrey, England

I was surprised when a Reader in Biochemistry told me that biochemical equations are rooted in Marshall's textbook of economics. Here Dr Chooi Lee, a consultant in geriatric medicine, uses the concepts that underpin biochemical equations to first explain why the NHS introduced physician leadership in diagnosis rehabilitation into long-term care, to describe what happened, and then to show how the original concepts were changed. She concludes by asking "Should a phoenix arise from the ashes of the past?" (Ed)

Here now are the newsletter-type items:

It's on and it's happening down under!

The Nosokinetics Group is pleased to announce that the International Conference on Health and Social Care Modelling and Applications (HSCM 2006) will be held at the University of Adelaide, Adelaide, South Australia, 19 - 21 April, 2006. A flyer regarding the conference will be sent to readers of NK News in a special separate mail-out. We urge you to make this a priority conference to attend; and to consider presenting a paper We thank the University of Adelaide (Department of Psychology), the South Australian Department of Health, CHIK Services Pty Ltd and The Health Roundtable Limited for their support. Peter Millard (International Chair) and Mark Mackay (Australian Chair)

Modelling the future: A policy flight simulator at the acute - aged care interface

AHMAC priority driven research program grant ($A300k over 3yrs)

Key Participants: Len Gray Professor of Geriatrics (University of Queensland), Professor Tony Broe (Prince of Wales Medical Research Institute, University of New South Wales), Diane Gibson (Australian Institute of Health and Welfare), and Geoff McDonnell Simulation Research Fellow (Centre for Health Informatics, University of New South Wales).

Research Question Focus: "How can current service mix and models of service provision for aged care be developed to meet expected changes in demand over the next 10 years?"

A series of future scenarios based on a range of potential policy directions surrounding the acute - aged care interface will be constructed. They will include alterations in the balance of care (between community and residential care), expansion of subacute care and reconfiguration of acute hospital based aged care services. The outcomes of these scenarios will be modeled using a multi-level, multi-method (combined system dynamics and agent based) computer Simulation Model centred around interactions between the 4 key programs that support aged care: acute care, subacute care, residential care and community care.

The Victorian patient flow collaborative

Marcus Kennedy, Director of Emergency Services, Royal Melbourne Hospital

The Victorian Patient Flow Collaborative is an ambitious innovation program designed to minimise waiting throughout the patient journey and to improve the quality and safety of patient care.

The Patient Flow Collaborative is a joint initiative between the Clinical Innovation Agency (CIA) and the Hospital Demand Management (HDM) team from the Metropolitan Health and Aged Care Service.

All metropolitan and large rural health services (21 Hospitals) from Victoria participate in the 18 month collaborative project. It is providing 18 months of whole system innovation and capacity building with improvement leads based at each site. A whole system approach to innovation, focusing on improving service delivery across the entire healthcare system is being implemented in four key phases:

diagnostic - conduct rigorous diagnosis to identify whole system constraints;
innovation - develop and test innovations to minimise flow constraints'
improvement skills building - develop service improvement skills and techniques
mainstream - spread innovation across other clinical areas and hospitals, ensure sustainability and embed innovation practice.

The Patient Flow Collaborative uses a range of tools to test and measure patient flow processes. Constraint Theory and Lean Thinking methodologies are integral to the program methodology. As the project has matured, increased interest in understanding queueing theories and modeling systems has occurred, to assist organisations in anticipating demand and creating capacity to match and manage this demand. Gains across the system are starting to be realised, with examples of quite dramatic constraint unlocking occurring in several areas. After the 1st 12 months, the work of this group is really a starting point only; long term adoption of at least a quasi-industrial approach to understanding patient flow is still to be established widely.

We are indebted to IMS MAXIMS plc's sponsorship for enabling the website version to be developed. IMS is a significant supplier to NHS and has an ongoing interest in enhancing the scope of IT support in the NHS, especially in the areas of clinical knowledge and decision support. Developers of systems looking for market opportunities are invited to contact IMS at their UK office, or by e-mail to Paul Cooper (pcooper at imsmaxims dot com). Accessing their web-site http://www.imsmaxims.com will give a feel for the scope of their work.

[Archive Overview]

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