Portsmouth Hospitals NHS Trust is investing £1.8M in a new Surgical Admissions Unit (SAU) at the Queen Alexandra Hospital (QAH). In line with their pioneering approach to healthcare delivery, Portsmouth Hospital NHS Trust decided to undertake a simulation-enabled approach to evaluating the proposed Surgical Assessment Unit.

The context of the current situation is set by:

• The introduction of Government 4-hour targets for dealing with A&E patients (initially 90%) implication of not meeting targets would result in a loss of funding of over £1 M
   
• The planned closure of 75 medical beds on the QAH site - there is already pressure on medical bed availability, so action is required to address this
   
• Patient demand rising at 7% per annum
   
• A new PFI hospital to be built for 2008 - any change needs to be sustainable over the next five years
   
• The pain experienced with the implementation of the Medical Admissions Unit (MAU) at QAH. The MAU was under-sized from day 1 and resulted in a host of problems for the Trust, including a cost of several million pounds to rectify the capacity shortfall.
   

In response to this, The Trust .is taking a process- centred approach to planning the care-pathways for General Surgical Emergency patients. Some 25% of patients presenting at A&E are General Surgical Emergencies, so achieving a high 4-hour performance level for these patients will have a significant impact on the overall A&E performance figure. The planned new process involves a Surgical Assessment Unit (SAU) undertaking more of the initial assessment of the patient, thus removing so me of the workload on A&E and speeding up the patien´s progress through the system. The SAU would concentrate the resource needed to assess emergency patients' surgical needs in one place - making the process faster and more efficient for the patient

It is critically important that the size of this facility (in terms of number of beds) and the resources operating within it are correct from the first day of operation. However, given the variable nature of both the emergency patient arrivals and subsequent length of stay in the unit it is very difficult to accurately plan using static modelling techniques. Simulation is used to overcome this problem.

WITNESS simulation-enabled approach is regularly used to assess capacity and resource requirements in the health sector by building a dynamic model of care pathways and allowing a multitude of "what-if" scenarios to be tested. In this manner the impact of proposed changes on performance measures, bed occupancy, resource utilisation etc. can be accurately quantified in a risk-free environment.