Emergency and on-demand health care: modelling a large complex system

Brailsford, S.C., Lattimer, V.A., Tarnaras, P. and Turnbull, J.C. (2004) Emergency and on-demand health care: modelling a large complex system. Journal of the Operational Research Society, 55, (1), 34-42. (doi:10.1057/palgrave.jors.2601667).


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This paper describes how system dynamics was used as a central part of a whole-system review of emergency and on-demand health care in Nottingham, England. Based on interviews with 30 key individuals across health and social care, a 'conceptual map' of the system was developed, showing potential patient pathways through the system. This was used to construct a stock-flow model, populated with current activity data, in order to simulate patient flows and to identify system bottle-necks. Without intervention, assuming current trends continue, Nottingham hospitals are unlikely to reach elective admission targets or achieve the government target of 82% bed occupancy. Admissions from general practice had the greatest influence on occupancy rates. Preventing a small number of emergency admissions in elderly patients showed a substantial effect, reducing bed occupancy by 1% per annum over 5 years. Modelling indicated a range of undesirable outcomes associated with continued growth in demand for emergency care, but also considerable potential to intervene to alleviate these problems, in particular by increasing the care options available in the community.

Item Type: Article
ISSNs: 0160-5682 (print)
Related URLs:
Keywords: emergency and on-demand health care, A&E, simulation, system dynamics, discrete event simulation, modelling
Subjects: H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
H Social Sciences > HV Social pathology. Social and public welfare
R Medicine > RA Public aspects of medicine
R Medicine > RT Nursing
Divisions: University Structure - Pre August 2011 > Superseded (SONM) > Superseded (HSR)
University Structure - Pre August 2011 > School of Management
ePrint ID: 9600
Date Deposited: 24 May 2006
Last Modified: 06 Aug 2015 02:13
URI: http://eprints.soton.ac.uk/id/eprint/9600

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