A simulation tool for better management of retinal services

Area of Science:

• Ophthalmology
• Health Services Research
• Health Economics

Background:

• Rapid advancements in retinal disease management increase patient numbers and treatment frequency.
• Current National Health Service (NHS) retinal services face capacity constraints, impacting patient follow-up intervals.
• Robust, long-term retinal service models are essential to meet current and future patient needs.

Purpose of the Study:

• To develop and utilize a discrete event simulation (DES) tool to optimize retinal service delivery.
• To identify efficiencies and cost savings within patient care pathways.
• To predict the impact of service changes on resource utilization and patient outcomes.

Main Methods:

• A discrete event simulation (DES) model was developed using 36 months of patient-level data.
• Statistical forecasting and simulation were employed to analyze a mid-size English hospital's retinal service.
• The model evaluated the 'Treat and Extend' (T&E) regimen combined with virtual clinics.

Main Results:

• Simulations showed that 'Treat and Extend' (T&E) alone increased follow-ups and resource use.
• Combining T&E with virtual clinics significantly improved quality, effectiveness, and productivity.
• The T&E and virtual clinic combination resulted in a negligible impact on resource utilization.

Conclusions:

• Service re-organization, including T&E and virtual clinics, enables expansion of retinal services.
• Initial investment in T&E and virtual clinics is offset by long-term cost reductions and improved patient outcomes.
• The modeled service demonstrated an average of 10% increase in surplus capacity.