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Professor Rickard’s plastic surgery clinics run every Tuesday afternoon at Derriford Hospital (14:00-17:30), and see around 25-30 patients a week, representing a mixture of patients, including complex new cancer patients, trauma patients and others. Currently, there is one consultant, a variable number of Registrars and SHOs, and one Cancer Nurse Specialist running the clinic.
Clinics are frequently running around 1 hour late very quickly after the clinic has started, leading to significant waits for patients, and overrun of the clinic for staff. The length of time needed for patient consultations varies significantly depending on the patient needs, and the collaborators feel that the current clinic slots don’t match well enough to the incoming activity.
The collaborators would like to know whether a) increasing the gap between appointments (but seeing fewer patients) or b) seeing patients with complex needs in a separate clinic could help to reduce delays for patients, and minimise overrun of the clinic.
We will build a simulation model to answer the following questions:
The modelling results demonstrated that significant improvements to patient waiting times and clinic overrun could be made if some relatively small changes were made to the clinic scheduling. Specifically, the model shows that appointments should be booked 10 minutes apart for consultant-led clinics and 15 minutes apart for registrar-led clinics and double booking of appointments should be avoided (currently around 20% of appointments are double booked). The model also predicts that only limited benefit could be gained from running separate clinics for patients with complex needs.
Derriford have already made the suggested changes for their next clinic and will be collecting data post-implementation so we can analyse if it’s had a real impact on waiting times and clinic overrun. If successful, discussions will take place to explore rolling out the changes to the 11 other plastic surgery clinics at Derriford. It will also be important to understand how the changes have affected the number of patients that can be seen in clinics.