Process modelling of NHS cardiovascular waiting lists in response to the COVID-19 pandemic

Catsis, S. et al. (2023) Process modelling of NHS cardiovascular waiting lists in response to the COVID-19 pandemic. BMJ Open, 13(7), e065622. (doi: 10.1136/bmjopen-2022-065622) (PMID:37474168)

Abstract

Objective: To model the referral, diagnostic and treatment pathway for cardiovascular disease (CVD) in the English National Health Service (NHS) to provide commissioners and managers with a methodology to optimise patient flow and reduce waiting lists. Study design: A systems dynamics approach modelling the CVD healthcare system in England. The model is designed to capture current and predict future states of waiting lists. Setting: Routinely collected, publicly available data streams of primary and secondary care, sourced from NHS Digital, NHS England, the Office of National Statistics and StatsWales. Data collection and extraction methods: The data used to train and validate the model were routinely collected and publicly available data. It was extracted and implemented in the model using the PySD package in python. Results: NHS cardiovascular waiting lists in England have increased by over 40% compared with pre- COVID-19 levels. The rise in waiting lists was primarily due to restrictions in referrals from primary care, creating a bottleneck postpandemic. Predictive models show increasing point capacities within the system may paradoxically worsen downstream flow. While there is no simple rate-limiting step, the intervention that would most improve patient flow would be to increase consultant outpatient appointments. Conclusions: The increase in NHS CVD waiting lists in England can be captured using a systems dynamics approach, as can the future state of waiting lists in the presence of further shocks/interventions. It is important for those planning services to use such a systems-oriented approach because the feed-forward and feedback nature of patient flow through referral, diagnostics and treatment leads to counterintuitive effects of interventions designed to reduce waiting lists.

• Item Type: Articles
• Additional Information: This study was funded by the British Heart Foundation, University Hospitals Bristol and Weston Charity and the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Enright, Dr Jessica
• Authors: Catsis, S., Champneys, A. R., Hoyle, R., Currie, C., Enright, J., Cheema, K., Woodall, M., Angelini, G., Nadarajah, R., Gale, C., and Gibbison, B.
• College/School: College of Science and Engineering > School of Computing Science
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Copyright Holders: Copyright © Author(s) (or their employer(s)) 2023
• First Published: First published in BMJ Open 13(7):e065622
• Publisher Policy: Reproduced under a Creative Commons licence