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A Simulation Modelling Study of Referral Distribution Policies in a Centralized Intake System for Surgical Consultation

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Abstract

Delays beyond recommended wait times, especially for specialist services, are associated with adverse health outcomes. The Alberta Surgical Initiative aims to improve the referral wait time—the time between a referral is received at the central intake to the time a specialist sees the patient. Using the discrete event simulation modelling approach, we evaluated and compared the impact of four referral distribution policies in a central intake system on three system performance measures (number of consultations, referral wait time and surgeon utilization). The model was co-designed with clinicians and clinic staff to represent the flow of patients through the system. We used data from the Facilitated Access to Surgical Treatment (FAST) centralized intake referral program for General Surgery to parameterize the model. Four distribution policies were evaluated – next-available-surgeon, sequential, "blackjack," and "kanban." A sequential distribution of referrals for surgical consultation among the surgeons resulted in the worst performance in terms of the number of consultations, referral wait time and surgeon utilization. The three other distribution policies are comparable in performance. The "next available surgeon" model provided the most efficient and robust model, with approximately 1,000 more consultations, 100 days shorter referral time and a 14% increase in surgeon utilization. Discrete event simulation (DES) modelling can be an effective tool to illustrate and communicate the impact of the referral distribution policy on system performance in terms of the number of consultations, referral wait time and surgeon utilization.

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Data Availability

The data used to parameterize the simulation study are available on request from the corresponding author, DM. The data are not publicly available due to restrictions.

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Funding

This research was funded by Alberta Health Services through the Strategic Clinical Networks™. Deborah A. Marshall received salary and research support as a Canada Research Chair and as the Arthur J.E Child Chair Professor.

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Authors and Affiliations

  1. Cumming School of Medicine, McCaig Bone and Joint Health Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z, Canada

    Deborah A. Marshall & Toni Tagimacruz

  2. Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada

    Monica Cepoiu-Martin

  3. Surgery, Alberta Health Services, Bone & Joint Strategic Clinical NetworkTM, Alberta, Canada

    Jill Robert

  4. Surgery Strategic Clinical NetworkTM, Alberta Health Services, Alberta, Canada

    Bernice Ring, Suzanne Higgins & Jonathan White

  5. Alberta Health Services, Alberta, Canada

    Michael Burston & Monica Hess

Authors
  1. Deborah A. Marshall
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  2. Toni Tagimacruz
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Correspondence to Deborah A. Marshall.

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Marshall, D.A., Tagimacruz, T., Cepoiu-Martin, M. et al. A Simulation Modelling Study of Referral Distribution Policies in a Centralized Intake System for Surgical Consultation. J Med Syst 47, 4 (2023). https://doi.org/10.1007/s10916-022-01897-x

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  • DOI: https://doi.org/10.1007/s10916-022-01897-x

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