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PenCHORD Projects

In order to achieve the best possible outcomes, PenCHORD projects involve close collaboration throughout their life cycle with NHS clinicians, managers, commissioners and patients. This approach has delivered successful outcomes across the region including; a three-fold increase in the number of stroke patients who are thrombolysed at Royal Devon and Exeter Hospital; a halving of patient wait times for mental health assessment in Devon, and; provided evidence to support an increase in the diabetic retinopathy screening interval to free up vital resources.

Full details of projects we have been involved in can be found by visiting the PenARC project pages and searching for "PenCHORD".

Or for more detailed information on a selection of completed projects, view our case studies.

If you have any queries regarding these projects or would like further information, or if you have a research question that you feel our analysis and modelling could assist with, please contact us.



Case studies

View case studies of some of our projects below:

Optimising polypharmacy prescribing practice using Agent-Based Simulation modelling

An ageing population has led to an increasing number of people with multiple comorbidities prescribed multiple medications, known as polypharmacy. We designed and built a proof-of-concept simulation model for use as a tool to support polypharmacy prescribing for those with Type 2 Diabetes and Asthma. Read more.

High-sensitivity troponin for the diagnosis of acute myocardial infarction in A&E – modelling impact and implementation in the South West

The use of high-sensitivity cardiac troponin was evaluated using discrete event simulation. We investigated changes in key performance indicators, including the number of admissions, and overall length of stay in ED and short stay wards. Reducing the interval between re-testing resulted in a significant reduction in patient time in ED and on short stay wards. Read more.

Using geographic modelling to assess the impact of Minor Injury Unit closures on travel time and attendances

A local commissioning group were looking to close four Minor Injury Units (MIUs) due to low numbers of attendances. In order to better inform their decision, they wanted to understand the potential impact on patient travel times and displacement to other services if these units were closed.  A geographic model to predict the impact of these closures was built. Read more.

Visualising and forecasting ophthalmology outpatient activity in North Devon

An analysis was conducted to visualise and predict future use of North Devon District Hospital's ophthalmology outpatient services. Clinic workload was visualised using geographic mapping techniques and forecasting models were used to predict activity. Outputs were used to inform where community based services, such as Virtual Clinics, should be located. Read more.

What are the factors that most influence demand for ambulances in South West England?

A map of factors that potentially influence demand for ambulance services was built, which was then translated into a simulation model, parameterised with data relevant to the population of South West England.  By running this model with each factor removed in turn, we were able to estimate those factors that are the biggest drivers for ambulance demand. Read more.

Planning theatre time to achieve 18 week elective targets

Simulation modelling was used to forecast waiting times for elective orthopaedic procedures at Yeovil District Hospital, using different theatre schedules and different rules for the allocation of patients to surgeons. The model indicated that the use of pooled waiting lists could reduce wait times and this approach has been implemented into the hospital's new theatre schedule. Read more.

GP appointment systems: How much can “Doctor First” help?

Doctor First is a GP appointment system aimed at reducing patient waiting times, as well as liberating time for GPs. Data from a pilot of the appointment system was used to build a simulation to examine its potential impact and compared these results with those as described by the originator of the scheme. Read more.

Planning neonatal capacity across a network of hospitals: centralisation vs. localisation

A simulation model was built to allow alternative configurations of neonatal services to be evaluated.  The model looked for the closest available cot, taking into account both infant needs and current neonatal workload, as well as examining the tension between centralisation and localisation of services. Read more.

Planning outpatient clinic service provision for TIA patients using location analysis

A facility location analysis model was developed to evaluate the consequences of different transient ischemic attack (TIA) clinic configurations in Cornwall. Provision of rapid assessment and treatment services is essential but particularly challenging in rural areas. The model evaluated the impact on equity of patient access, depending on different clinic locations. Read more.

Allocating patients to community teams: by GP or home location?

The aim of this project was to assess the workload of community teams in Plymouth by comparing two methods of allocating patients to teams; (i) patient allocation by patient home address, and (ii) patient allocation by patient GP. We found that allocating patients by GP resulted in approximately 30% of additional travel time and costs compared with allocating patients by home address. Read more.

Is it operationally practicable for fractured neck of femur patients to remain in an acute hospital during their rehabilitation?

Fractured neck of femur patients are typically treated in an acute hospital and then discharged to a community hospital for rehabilitation after surgery. PenCHORD were asked to build a simulation model to assess the practicability of retaining fractured neck of femur patients in the acute trauma ward for the duration of their rehabilitation. Read more.

Application of simulation and queuing theory to scheduling community mental health assessment

PenCHORD were asked to evaluate the planned roll-out of a “choose and book” telephone booking system for mental health assessment across Devon. Simulation was used to calculate how many appointment slots were needed to meet waiting time targets. Implementation of the system resulted in significantly reduced waiting times for mental health assessment across the county. Read more.

Can the retinal screening interval be safely increased to two years for Type 2 diabetic patients without retinopathy?

Agent-based simulation was used to predict the impact on patient vision of screening patients with Type 2 diabetes for diabetic retinopathy every two years, rather than annually, for those who had yet to developed retinopathy. The model predicted there would be no impact on patient vision if screening was reduced, whilst there could be a 25% saving in screening costs. Read more.

Redesigning emergency stroke pathways to maximise Thrombolysis rates

Computer simulations explored the different ways in which people who have suffered a stroke are managed from arrival at hospital to receiving clot-busting, disability-saving treatment. Recommendations based on the results were implemented at the Royal Devon & Exeter Hospital and follow-up studies indicate there has been a significant improvement in both thrombolysis rates and the time taken to treat. Read more.

Upcoming Events


Searching and Review Clinic

Online appointments via Microsoft Teams

COVID-19 update: As a result of the pandemic, all PenARC staff are currently working remotely. While...
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Making Sense of Care Homes...


This workshop is aimed at researchers from across PenARC and Exeter University who are (or who are interested...
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£2.5 million to study group treatment programme for people with severe obesity

25 September 2020

Photo credit World Obesity Federation A team of researchers has been awarded nearly £2.5 million from...
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Operational Research to help improve patients’ experience of mental health services in the South West

22 September 2020

Computer modelling is helping to develop a tool that supports decision-making for patients and clinicians...
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NIHR ARCs awarded £13.125 million to fund key national research priorities

08 September 2020

The National Institute for Health Research Applied Research Collaborations (NIHR ARCs) have secured £13.125 million...
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Research Projects

Modelling demand and capacity for NHS Trusts in the South West

Theme: ARC - Methods for Research & Improvement

A tool has been developed to support forecasting resource demand and staffing capacity in NHS...
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Research Projects