The Efficiency of Increasing the Capacity of Physiotherapy Screening Clinics or Traditional Medical Services to Address Unmet Demand in Orthopaedic Outpatients: A Practical Application of Discrete Event Simulation with Dynamic Queuing.
BACKGROUND
Hospital outpatient orthopaedic services traditionally rely on medical specialists to assess all new patients to determine appropriate care. This has resulted in significant delays in service provision. In response, Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services (OPSC) have been introduced to assess and co-ordinate care for semi- and non-urgent patients.


OBJECTIVE
To compare the efficiency of delivering increased semi- and non-urgent orthopaedic outpatient services through: (1) additional OPSC services; (2) additional traditional orthopaedic medical services with added surgical resources (TOMS + Surg); or (3) additional TOMS without added surgical resources (TOMS - Surg).


METHODS
A cost-utility analysis using discrete event simulation (DES) with dynamic queuing (DQ) was used to predict the cost effectiveness, throughput, queuing times, and resource utilisation, associated with introducing additional OPSC or TOMS ± Surg versus usual care.


RESULTS
The introduction of additional OPSC or TOMS (±surgery) would be considered cost effective in Australia. However, OPSC was the most cost-effective option. Increasing the capacity of current OPSC services is an efficient way to improve patient throughput and waiting times without exceeding current surgical resources. An OPSC capacity increase of ~100 patients per month appears cost effective (A$8546 per quality-adjusted life-year) and results in a high level of OPSC utilisation (98 %).


CONCLUSIONS
Increasing OPSC capacity to manage semi- and non-urgent patients would be cost effective, improve throughput, and reduce waiting times without exceeding current surgical resources. Unlike Markov cohort modelling, microsimulation, or DES without DQ, employing DES-DQ in situations where capacity constraints predominate provides valuable additional information beyond cost effectiveness to guide resource allocation decisions.
Menzies Health Institute Queensland and Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, QLD, 4131, Australia. lachlan.standfield@griffithuni.edu.au.
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Standfield
Menzies Health Institute Queensland and Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, QLD, 4131, Australia.|Metro North Hospital and Health Service, Herston, Brisbane, QLD, 4029, Australia.
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Comans
Physiotherapy Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Brisbane, QLD, 4029, Australia.
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Raymer
Physiotherapy Department, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Brisbane, QLD, 4029, Australia.|Physiotherapy Department, School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia.
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O'Leary
Menzies Health Institute Queensland and Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, QLD, 4131, Australia.
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Moretto
Menzies Health Institute Queensland and Centre for Applied Health Economics, School of Medicine, Griffith University, Meadowbrook, QLD, 4131, Australia.
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Scuffham
D001315:Australia; D057191:Capacity Building / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational / Q000191:economics; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data; D018803:Models, Economic; D020380:Needs Assessment / Q000191:economics / Q000458:organization & administration; D009985:Orthopedics / Q000191:economics* / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000191:economics* / Q000458:organization & administration; D026761:Physical Therapy Specialty / Q000191:economics*; D011793:Queensland; D000078329:Workforce