Development and calibration of a constrained resource health outcomes simulation model of hospital-based glaucoma services

Health service delivery and organization often develops in an ad hoc manner, in response to unplanned changes in referral patterns, technologies and system-level factors. We developed a discrete event simulation model for the analysis of health services in a routine clinical setting, with the objective of predicting the process impact of variations to current forms of service delivery and organization. As a case study, we use glaucoma services provided at the Royal Adelaide Hospital, South Australia. Both clinical and administrative hospital data were used to populate and calibrate the model. A random search strategy of a constrained parameter space identified convergent input parameter sets, representing the current operation of glaucoma services at the hospital. Analyses of alternative service configurations showed that extending the patient booking cycle, and review times for stable patients lowered patient numbers per clinic and decreased delays. Applied health services can be successfully simulated and calibrated, providing a basis for analyses of patient throughput, and potentially the economic evaluation of alternative approaches to organizing such services.