Simul8 Healthcare Resources

Using B-natriuretic peptide testing to assist in the early, accurate diagnosis of heart failure improves patient outcomes and reduces costs and is part of The National Institute for Health and Clinical Excellence (NICE) guidance.

Simul8 simulation software was used to help Primary Care Trust to simulate the impact of implementation. By seeing the simulated improvement in patient outcomes and reduction in costs—£13.7m a year nationally – PCTs were able to make the decision to adopt the guidance.

Evidence-based Decision-Making in Heart Failure

Heart failure referrals currently cost the NHS more than £35million per year and NHS Improvement projects have shown that of patients referred for heart failure, up to 70% do not have it and more than 30% have no cardiac cause for their symptoms. B-natriuretic peptide is a simple blood test that can be used to rule out heart failure with 98% accuracy and for those identified, diagnosis and treatment can be accelerated and patient outcomes improved.

A survey of cardiac networks by NHS Improvement in August 2009 showed that only 46% of primary care trusts (PCTs) provided this test in primary care.

Simul8 was used as a timely, cost effective method for establishing the effect of introducing the test, its impact on patient outcomes and overall costs savings.

The simulation was originally created by East Riding PCT and NHS Improvement subsequently developed it further for national use to speed up adoption.

Evidence for Change

The current heart failure pathway was created in Simul8 simulation software using population and prevalence data, and the pathway costs calculated. The proposed new pathway to include serum NP testing was then mapped and costed as before.

A number of best and worst case scenarios were also developed in order to explore all the potential ways the test could be implemented. The resulting cost modelling was then presented to commissioners and clinicians in each PCT and discussed so that they could choose the pathway that best suited their requirements.

Following the implementation of the test, each PCT modelled has been followed up and had the results validated against the predicted savings shown in the simulation.

As a result of the modelling a further 27 PCTs have asked for modelling and this has been completed in 13 giving total predicted savings of £2.67m per year.

The number of chronic disease cases is growing at phenomenal rates as our general population ages. End-stage diseases of all the major organs: heart, lung, liver, kidney and pancreas ultimately rely on transplantation as the only means remaining to return a patient to reasonable health.

Because of this growth in demand, the line of patients waiting to receive organ transplants is seemingly endless. Aside from the fact that there are not enough organs being donated to meet this need, the transplant community's next biggest problem is having sufficient resources to meet the increasing demand.

The Challenge

Transplantation care has traditionally involved following every patient for life. Today, however, resources to follow these patients indefinitely are taxed to the limit in an environment where pressures to restrict healthcare spending prevail.

NovaSim, one of our most valued Simul8 Certified Solution Providers, worked with Johns Hopkins in developing simulation as an essential tool in their efforts to improve process efficiency. It is critical that these steps be taken today so that the Johns Hopkins Comprehensive Transplant Center will be in a position to keep pace with the increasing demand for transplant care in the future.

In any healthcare setting, the needs of each patient are unique. This is particularly true of transplant care. Each patient progresses through a series of treatment phases, with each phase requiring a different mix of staff resources and treatment times. Many of the staff resources are highly specialized, and have complex availability patterns due to the need to fulfill responsibilities in other departments of the hospital.

The Solution

Using simulation, Johns Hopkins has emulated the very complex process that is involved in every transplant case. After filling-in the necessary staff resources required, time commitments were established for all of the various tasks they perform.

With this as a starting point they were able to simulate the flow-through of each of the various stages leading to transplant and then chronic follow-up. Ultimately they were able to model the flow of the entire process so that it reasonably replicates what happens in the hospital.

The Result

Having achieved this level of validation, Johns Hopkins has successfully identified the areas that will allow them to automate steps to off-load staff responsibilities. In addition, they can clearly see the effect that outsourcing various steps of the process will have to limit internal growth of the center and still maintain quality of care.

These simulation modeling efforts have helped them to understand how all of the complex elements involved in transplant care fit together, enabling Johns Hopkins to better use its limited resources to the advantage of their patients.