Anderson, G. H., Jenkins, P. J., McDonald, D. A., Van Der Meer, R., Morton, A., Nugent, M. and Rymaszewski, L. A. (2017) Cost comparison of orthopaedic fracture pathways using discrete event simulation in a Glasgow hospital. BMJ Open, 7(9), e014509. (doi: 10.1136/bmjopen-2016-014509) (PMID:28882905) (PMCID:PMC5595193)
|
Text
149467.pdf - Published Version Available under License Creative Commons Attribution Non-commercial. 1MB |
Abstract
Objective: Healthcare faces the continual challenge of improving outcome while aiming to reduce cost. The aim of this study was to determine the micro cost differences of the Glasgow non-operative trauma virtual pathway in comparison to a traditional pathway. Design: Discrete event simulation was used to model and analyse cost and resource utilisation with an activity-based costing approach. Data for a full comparison before the process change was unavailable so we used a modelling approach, comparing a virtual fracture clinic (VFC) with a simulated traditional fracture clinic (TFC). Setting: The orthopaedic unit VFC pathway pioneered at Glasgow Royal Infirmary has attracted significant attention and interest and is the focus of this cost study. Outcome: measures Our study focused exclusively on patients with non-operative trauma attending emergency department or the minor injuries unit and the subsequent step in the patient pathway. Retrospective studies of patient outcomes as a result of the protocol introductions for specific injuries are presented in association with activity costs from the models. Results: Patients are satisfied with the new pathway, the information provided and the outcome of their injuries (Evidence Level IV). There was a 65% reduction in the number of first outpatient face-to-face (f2f) attendances in orthopaedics. In the VFC pathway, the resources required per day were significantly lower for all staff groups (p≤0.001). The overall cost per patient of the VFC pathway was £22.84 (95% CI 21.74 to 23.92) per patient compared with £36.81 (95% CI 35.65 to 37.97) for the TFC pathway. Conclusions: Our results give a clearer picture of the cost comparison of the virtual pathway over a wholly traditional f2f clinic system. The use of simulation-based stochastic costings in healthcare economic analysis has been limited to date, but this study provides evidence for adoption of this method as a basis for its application in other healthcare settings.
Item Type: | Articles |
---|---|
Additional Information: | This study was funded by the Scottish Government Quality and Efficiency Support Team. |
Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | Rymaszewski, Mr Lech and Jenkins, Mr Paul |
Authors: | Anderson, G. H., Jenkins, P. J., McDonald, D. A., Van Der Meer, R., Morton, A., Nugent, M., and Rymaszewski, L. A. |
College/School: | College of Medical Veterinary and Life Sciences > School of Infection & Immunity College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
Journal Name: | BMJ Open |
Publisher: | BMJ Publishing Group |
ISSN: | 2044-6055 |
ISSN (Online): | 2044-6055 |
Published Online: | 07 September 2017 |
Copyright Holders: | Copyright © 2017 The Authors |
First Published: | First published in BMJ Open 7(9): e014509 |
Publisher Policy: | Reproduced under a Creative Commons license |
University Staff: Request a correction | Enlighten Editors: Update this record