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Examining the effect of interventions in emergency care for older people using a system dynamics decision support tool

Examining the effect of interventions in emergency care for older people using a system dynamics decision support tool
Examining the effect of interventions in emergency care for older people using a system dynamics decision support tool

Background: Rising demand for Emergency and Urgent Care is a major international issue and outcomes for older people remain sub-optimal. Embarking upon large-scale service development is costly in terms of time, energy and resources with no guarantee of improved outcomes; computer simulation modelling offers an alternative, low risk and lower cost approach to explore possible interventions. Method: A system dynamics computer simulation model was developed as a decision support tool for service planners. The model represents patient flow through the emergency care process from the point of calling for help through ED attendance, possible admission, and discharge or death. The model was validated against five different evidence-based interventions (geriatric emergency medicine, front door frailty, hospital at home, proactive care and acute frailty units) on patient outcomes such as hospital-related mortality, readmission and length of stay. Results: The model output estimations are consistent with empirical evidence. Each intervention has different levels of effect on patient outcomes. Most of the interventions show potential reductions in hospital admissions, readmissions and hospital-related deaths. Conclusions: System dynamics modelling can be used to support decisions on which emergency care interventions to implement to improve outcomes for older people.

Emergency and urgent care, Frailty, Interventions, Older people, System Dynamics, frailty, system dynamics, interventions, emergency and urgent care, older people
0002-0729
England, Tracey
8f99b32a-1670-4e20-b6c6-30ae96940ca2
Brailsford, Sally
634585ff-c828-46ca-b33d-7ac017dda04f
Evenden, Dave
e21cd9fe-cf12-4c43-9498-f73c0b5a5b98
Street, Andrew
7e17054f-0249-4d43-a280-154ae16225a0
Maynou, Laia
d2146913-de7d-4b23-9f47-b0ac938ea684
Mason, Suzanne
384d6aa2-e70c-480b-b418-438db6875dab
Preston, Louise
6c8081a6-81d2-49ce-9f4f-6daf8ed23f9b
Burton, Christopher
8a50805c-1024-4309-8750-1c4c53468a14
Van Oppen, James
642e4b90-bb98-4b60-a9f2-069a923f8a65
Conroy, Simon
1a33aa87-25a8-4083-8418-b7d73eb99110
England, Tracey
8f99b32a-1670-4e20-b6c6-30ae96940ca2
Brailsford, Sally
634585ff-c828-46ca-b33d-7ac017dda04f
Evenden, Dave
e21cd9fe-cf12-4c43-9498-f73c0b5a5b98
Street, Andrew
7e17054f-0249-4d43-a280-154ae16225a0
Maynou, Laia
d2146913-de7d-4b23-9f47-b0ac938ea684
Mason, Suzanne
384d6aa2-e70c-480b-b418-438db6875dab
Preston, Louise
6c8081a6-81d2-49ce-9f4f-6daf8ed23f9b
Burton, Christopher
8a50805c-1024-4309-8750-1c4c53468a14
Van Oppen, James
642e4b90-bb98-4b60-a9f2-069a923f8a65
Conroy, Simon
1a33aa87-25a8-4083-8418-b7d73eb99110

England, Tracey, Brailsford, Sally, Evenden, Dave, Street, Andrew, Maynou, Laia, Mason, Suzanne, Preston, Louise, Burton, Christopher, Van Oppen, James and Conroy, Simon (2023) Examining the effect of interventions in emergency care for older people using a system dynamics decision support tool. Age and Ageing, 52 (1), [afac336]. (doi:10.1093/ageing/afac336).

Record type: Article

Abstract

Background: Rising demand for Emergency and Urgent Care is a major international issue and outcomes for older people remain sub-optimal. Embarking upon large-scale service development is costly in terms of time, energy and resources with no guarantee of improved outcomes; computer simulation modelling offers an alternative, low risk and lower cost approach to explore possible interventions. Method: A system dynamics computer simulation model was developed as a decision support tool for service planners. The model represents patient flow through the emergency care process from the point of calling for help through ED attendance, possible admission, and discharge or death. The model was validated against five different evidence-based interventions (geriatric emergency medicine, front door frailty, hospital at home, proactive care and acute frailty units) on patient outcomes such as hospital-related mortality, readmission and length of stay. Results: The model output estimations are consistent with empirical evidence. Each intervention has different levels of effect on patient outcomes. Most of the interventions show potential reductions in hospital admissions, readmissions and hospital-related deaths. Conclusions: System dynamics modelling can be used to support decisions on which emergency care interventions to implement to improve outcomes for older people.

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Age and Ageing manuscript_03022022V2 - Accepted Manuscript
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e-pub ahead of print date: 23 January 2023
Published date: 23 January 2023
Additional Information: Publisher Copyright: © 2023 The Author(s). Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved.
Keywords: Emergency and urgent care, Frailty, Interventions, Older people, System Dynamics, frailty, system dynamics, interventions, emergency and urgent care, older people

Identifiers

Local EPrints ID: 474654
URI: http://eprints.soton.ac.uk/id/eprint/474654
ISSN: 0002-0729
PURE UUID: 3c702990-104d-4883-9b3f-3c4a42294392
ORCID for Tracey England: ORCID iD orcid.org/0000-0001-7565-4189
ORCID for Sally Brailsford: ORCID iD orcid.org/0000-0002-6665-8230

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Date deposited: 28 Feb 2023 17:50
Last modified: 17 Jun 2024 16:30

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Contributors

Author: Tracey England ORCID iD
Author: Dave Evenden
Author: Andrew Street
Author: Laia Maynou
Author: Suzanne Mason
Author: Louise Preston
Author: Christopher Burton
Author: James Van Oppen
Author: Simon Conroy

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