Simulation of waiting time and effectiveness in hospitals

Many Norwegian hospitals have to cancel elective surgery because of acute cases, and ring fencing of elective surgery is a frequently discussed measure. In this article we discuss advantages and disadvantages of ring fencing in relation to the results from a simulation model. Model simulations were done in the computer program Powersim Constructor 2.5. We found that combined acute and elective departments are expected to have shorter waiting time and less use of overtime compared with separate acute and elective departments, as more flexible use of capacity results in higher average capacity utilization. In a combined department, elective patients run the risk of having their operation cancelled, but they may expect a shorter waiting time before treatment. Our results indicate that ring fencing in itself is not beneficial, as total capacity utilization declines. On the other hand, separate departments may facilitate an increase in efficiency in the elective surgery department; this may shorten waiting time.