DES Patient Pathway

This patient pathway model is designed to simulate a typical acute hospital outpatient, admission, treatment, and followup pathways. It uses Discrete Event Simulation (DES) methodology, and is implemented using the open-source {simmer} R package.

It is designed to be used by hospital management and clinicians to investigate service configuration options. It models a single pathway, and is configurable so that users can experiment with “what if” questions.

It presents results graphically wherever possible (some of this is still in development).

Model configuration options

The model uses a blend of hard-coded assumtions, and a set of configurable options. Over time (or by request), options that are currently hard-coded may be made user-configurable.

Examples of configurable items (some are under development):

• Number of weeks to forecast ahead (default is 2 years)
• Patient referral (arrival) rate
• Conversion rate (from OP appointment to admission / treatment waiting list)
• Outpatient appointment followup rate (what proportion of OP appts are new vs. followups)
• Existing service waiting list (backlog size)
• Outpatient clinics:
  • Number of clinics (schedule)
  • OP clinic appointment length
• Pre-operative ward:
  • Number of beds
  • Patient average length-of-stay
• Post-operative ward:
  • Number of beds
  • Patient average length-of-stay
• Operating theatre
  • Operating hours (schedule)
  • Average procedure length

Examples of currently hard-coded items:

• Distributions (variation) of length-of-stay, and theatre procedure length
• OP clinics and Operating theatres are currently assumed to be the same every day (ie. 7 day service). The ability to define weekly capacities is planned in due course.
• Appointment non-attendance (DNA - did not attend) is not currently modelled. Attendance is assumed to be 100%

Installation

You can install DESPatientPathway like so:

# install.packages("remotes")
remotes::install_github("ThomUK/DESPatientPathway", build_vignettes = TRUE)

Run the app locally

To run the app on your local machine, use the below:

library("DESPatientPathway")
run_app()

or simply:

DESPatientPathway::run_app()