Evaluating the impact of a simulation study in emergency stroke care

Monks, Thomas; Pearson, Mark; Pitt, Martin; Stein, Ken; James, Martin A.

Abstract

© 2015 The Authors. Very few discrete-event simulation studies follow up on recommendations with evaluation of whether modelled benefits have been realised and the extent to which modelling contributed to any change. This paper evaluates changes made to the emergency stroke care pathway at a UK hospital informed by a simulation modelling study. The aims of the study were to increase the proportion of people with strokes that undergo a time-sensitive treatment to breakdown a blood clot within the brain and decrease the time to treatment. Evaluation involved analysis of stroke treatment pre- and post-implementation, as well as a comparison of how the research team believed the intervention would aid implementation compared to what actually happened. Two years after the care pathway was changed, treatment rates had increased in line with expectations and the hospital was treating four times as many patients than before the intervention in half the time. There is evidence that the modelling process aided implementation, but not always in line with expectations of the research team. Despite user involvement throughout the study it proved difficult to involve a representative group of clinical stakeholders in conceptual modelling and this affected model credibility. The research team also found batch experimentation more useful than visual interactive simulation to structure debate and decision making. In particular, simple charts of results focused debates on the clinical effectiveness of drugs - an emergent barrier to change. Visual interactive simulation proved more useful for engaging different hospitals and initiating new projects.

Citation

Monks, T., Pearson, M., Pitt, M., Stein, K., & James, M. A. (2015). Evaluating the impact of a simulation study in emergency stroke care. Operations research for health care, 6, 40-49. https://doi.org/10.1016/j.orhc.2015.09.002

• Journal Article Type: Article
• Acceptance Date: Sep 6, 2015
• Online Publication Date: Sep 16, 2015
• Publication Date: Sep 1, 2015
• Deposit Date: Mar 1, 2018
• Publicly Available Date: Mar 22, 2018
• Journal: Operations Research for Health Care
• Print ISSN: 2211-6923
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 6
• Pages: 40-49
• DOI: https://doi.org/10.1016/j.orhc.2015.09.002
• Keywords: Surgery; Oral Surgery; Otorhinolaryngology
• Public URL: https://hull-repository.worktribe.com/output/554272
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S2211692314200348?via%3Dihub
• Additional Information: This article is maintained by: Elsevier; Article Title: Evaluating the impact of a simulation study in emergency stroke care; Journal Title: Operations Research for Health Care; CrossRef DOI link to publisher maintained version: http://dx.doi.org/10.1016/j.orhc.2015.09.002; Content Type: article; Copyright: Copyright © 2015 The Authors. Published by Elsevier Ltd.